ABSTRACT
Objective To report the surgical methods and results of pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder.Methods From August 2010 to April 2014,19 patients with locally advanced bladder cancer (cT2-3 N0-2 M0) underwent pure laparoscopic radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.Perioperative and follow-up data were collected.Results The surgeries were successful in all 19 cases with the operating time ranging from 261 to 380 min,blood loss of 100 to 350 ml.Postoperative hospital stay was 21±4 (15-26) days,postoperative intestinal function recovery time at 1.9±0.4 (1.5-2.3) days.Surgical margins were all negative.Lymph node positive rate was 32％ (6/19).Complications were including 1 case of lymphatic leakage; 3 cases of new bladder and urethra anastomotic fistula.There were 17 cases of urinary incontinence,all these cases were improved after 3 months,but there were still 8 cases of night-time incontinence.Three cases had unilateral ureteral reflux,ureter mild hydrocephalus,1 of the cases had recurrent infections within 1 month after surgery.After the anti-inflammatory and catheterization treatment,the symptoms were improved.Two cases had unilateral ureteral anastomotic stricture,one underwent percutaneous nephrostomy and cystoscope-assisted double J tube placement,another underwent laparoscopic ureteral neobladder reimplantation.One case had bilateral ureteral stenosis due to recurrent infections,and underwent bilateral laparoscopic ureteral-new bladder reimplantation.Patients were followed up for 8-42 months,no recurrence or distant metastasis was found.Conclusion Pure laparoscopic radical cystectomy with endo-GIA assisted orthotopic U-shape ileal neobladder can reduce surgical trauma and help patient's postoperative recovery.