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【Objective】 To explore the application of 1.2 mm×35 mm thin walled, long oblique angle syringe needle guided double-J tube insertion through abdominal wall in total laparoscopic ileal neobladder surgery. 【Methods】 Clinical data of 5 patients undergoing total laparoscopic ileal neobladder surgery in our hospital during Dec.2020 and Jan.2022 were retrospectively analyzed. Under laparoscopy and direct vision, 3 cm above pubic symphysis was taken as the puncture point, and an syringe needle was inserted to establish a channel. After that, a double-J tube was inserted under the guidance of the guide wire through the needle. 【Results】 The double-J tube was successfully implanted in all 5 patients. The time needed was 2-4 min, with an average of 3 min. 【Conclusion】 Under the guidance of a 1.2 mm×35 mm syringe needle, the placement of a double-J tube through the abdominal wall in total laparoscopic ileal neobladder surgery is safe, effective, simple and accurate. It can not only preserve the original operation channel without destroying the pneumoperitoneum, but also shorten the operation time. It is a new auxiliary means in total laparoscopic ileal neobladder surgery.
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The patient, a 56-year old male, was admitted to the hospital for recurrent bladder cancer in November 29, 2021. The patient had previously undergone partial cystectomy, simultaneous radio-chemotherapy to preserve the bladder, and repeated 4 times TURBt. CT suggested T 3 stage bladder cancer in left bladder wall, and causing left hydronephrosis. Under general anesthesia, robot-assisted laparoscopic radical cystectomy and complete intraperitoneal orthotopic ileal neobladder reconstruction were performed. The operation was successful, the postoperative recovery was good, and the patient was discharged 7 days after surgery. Postoperative pathological diagnosis was T 2b, high-grade urothelial carcinoma with left pelvic lymph node metastasis. Three months after operation, the patient had no recurrence, the new bladder function was good, the urine could be completely controlled during the day, and the intestinal and renal functions recovered well. At present, we carried out adjuvant chemotherapy (Gemcitabine+ Cisplatin)to this patient. The technical of radical cystectomy and orthotopic ileal neobladder with a history of surgery and radiotherapy is high, expensive experience in laparoscopic surgery and elaborate actions of robotic surgery are important prerequisites for completing such surgery.
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Objective:To investigate the experience and results of the modified lateral prostate capsule sparing robot-assisted radical cystectomy-orthotopic ileal neobladder (LPCS-RARC-OIN).Methods:From December 2018 to November 2020, 19 patients received LPCS-RARC-OIN by a single surgeon in Sun Yat-sen Memorial Hospital, Sun Yat-sen University. LPCS-RARC-OIN was performed on male patients with high-risk non-muscle-invasive bladder cancer or muscle-invasive bladder cancer cT 2N 0M 0 without tumour in the bladder neck or urethra, and prostate cancer was ruled out by MRI and serum PSA<2.5ng/ml. The average age was 57.6 years, the average IIEF-5 score was 20.4. Separating the prostatic adenoma and the lateral prostate capsule from the base to the apex of the prostate, and retaining the lateral prostate surgical capsule or lateral prostate capsule about 1-2mm thickness. Patients were followed up and urinary function, sexual function and oncological outcomes were recorded. Results:All 19 operations were finished successfully. The average operation time was 279.9 (225-345) min and average estimated blood loss was 88.9 (30-200) ml. The average postoperative hospital stays was 15.8 (9 -23) days. The average lymph node yields was 23.3 (11-42). All surgical margins were negative and no incidental prostate cancer was found. 2 weeks, 1 month, 3 months and 6 months after catheter removal, the daytime and nighttime continence were 42.1% (8/19)and 36.8% (7/19), 63.2% (12/19)and 63.2% (12/19), 78.9% (15/19) and 73.7% (14/19), 94.7% (18/19) and 89.5% (17/19), respectively. 3 months and 6 months after operation, the average IIEF-5 score was 7.2 and 10.1 points respectively. The average follow-up was 10.6 months (5.4-26.1 months)and no recurrence or distant metastasis was found in this study.Conclusions:LPCS-RARC-OIN could improve the urinary and sexual function in selected patients. However, the long-term follow up is needed for functional and oncological outcomes.
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Objective To discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy (RARC) with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Methods Between October 2014 and April 2019,71 patients(59 males and 12 females)with MIBC (Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic "U" shaped ileal neobladder in Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College) were studied retrospectively.They had an average age of (65.2 ± 5.6)y and BMI of (22.18 ± 3.75) kg/m2.The median age-adjusted charlson comorbidity index (aCCI) was 4,median ASA score was 2.All patients underwent these inspections pre-RARC:chest Xray,vascular ultrasound (jugular vein included),abdominal ultrasound,CT urography,cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour).All patients were pathological diagnosed with MIBC,with no evidence of systemic metastasis and no history of radiotherapy,systemic chemotherapy and open abdominal surgery before RARC.All 71 patients received RARC with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Between October 2014 and September 2016,37 cases (29 males and 8 females) were managed without ERAS protocols perioperatively.They had an average age of (65.3 ±5.7)y and BMI of (23.66 ± 3.47)kg/m2.The median aCCI was 4,median ASA score was 2.Between October 2016 and April 2019,another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment,thrombosis prevention,pain assessment and management,perioperative diet management etc.They had an average age of (64.5 ± 4.3) y and BMI of (21.87 ± 4.85) kg/m2.The median aCCI was 4,median ASA score was 2.There were no statistical significance between the two groups with regard to general information.Surgical and follow-up data were collected for all patients.Results Surgeries were successful in all 71 cases with postoperative follow up for 3-51 months.In ERAS group,there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours:with 2 cases of incidental prostate cancer (IPCa).In non-ERAS group,pT2 in 25 cases and pT3 in 12 cases:with 1 case of IPCa.Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5 ± 18.7) h vs.(29.9 ± 17.4)h,P =0.032],the first defecation time [(72.6 ±27.1)h vs.(88.7 ±35.8)h,P =0.004],length of hospital stay after surgey [(14.1 ± 3.3) d vs.(16.2 ± 4.8) d,P =0.037],numeric rating scales (NRS) Pain Score 8.0,24.0,48.0 h after surgery [(3.2 ±0.5)vs.(3.6 ±0.8),P =0.015;(1.9 ±0.3) vs.(2.2 ± 0.6),P =0.011;(1.3 ± 0.4) vs.(1.6 ± 0.7),P =0.032],respectively.There were no significance between groups with regard to operating time [(290 ± 65) min vs.(282 ± 46) min,P =O.549],intraoperative blood loss [(190.5 ± 235.6) ml vs.(221.1 ± 250.3) ml,P =0.438],transfusion rate [5.9％ (2/34) vs.8.1％ (3/37),P =0.922],readmission within 30 days after surgery [2.9％ (1/34) vs.5.4％ (2/37),P =0.940],early severe complications(within 30 days) [2.9％ (1/34) vs.2.7％ (1/37),P =0.940],late severe complications (after 30 days) [5.9％ (2/34) vs.8.1％ (3/37),P =0.922].Conclusions The implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic "U" shaped ileal neobladder using STAPLER technique is safe and effective.It can reduce postoperative pain and hospital stay,shorten bowel recovery time,improve early functional recovery without increasing major complications.This adoption should be encouraged.
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Objective To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder,and to summarize the experiences.Methods The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed.All patients were male,aged 33 to 77 years,with an average of 64.4 years.Body mass index ranged from 18.0 to 31.8 kg/m2,with an average of 23.2 kg/m2.One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor,with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma.No case underwent neoadjuvant therapy,and all cases were clinically staged as cT2a-3b N0-2 M0.Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed.The specific procedures were described as follows.After bladder resection,the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve,with the proximal part retaining 15 cm lumen as the input loop,and the distal part of 40 cm ileum being folded in 1∶1 ratio.The folded intestinal segment was made into a allantoic sac by using a linear incision closure device,forming a “ρ” shape with the input loop,bilateral ureters and the input loop.Anastomosis of wall,distal end of allantoic and urethra was performed.Record the perioperative data such as operation time,estimated bleeding,postoperative recovery,complications,and follow-up results.Result All of the 11 cases underwent successfully operation,and no cases were transferred to open surgery.The operation time ranged from 320 to 440 minutes,with an average of 357.1 minutes.The estimated amount of bleeding ranged from 100 to 300 ml,with an average of 207.1 ml.The total time of intestinal tract procedure was 80-100 minutes,with an average of 89.3 minutes,and the time of allantoic preparation was 14-19 minutes,with an average of 16.1 minutes.The pain score was 2-5 points at 4 hours after operation,with an average of 3.8 points,and 1-4 points at 24 hours after operation,with an average of 2.3 points.Postoperative exhaust time ranged from 2.5 to 3.5 days,with an average of 3.0 days.Catheter removed 21 days after operation,with 9 cases of urinary incontinence,including mild in 6 cases,moderate in 2 cases and severe in 1 case,with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks.Postoperative hospital stay ranged from 7 to 13 days,with an average of 10.4 days.The drainage removal time was 4-11 days,with an average of 6.7 days.Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma,3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma.The tumors invade the prostate in adenocarcinoma patient,with left (3/13) and right (1/9) positive lymph nodes.One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes,and the other cases were negative.The margin were negative in all patients.Pathological staging was pT2a-4a N0-2 M0.Postoperative adjuvant chemotherapy with gemcitabine + cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks,with an average of 17.4 weeks,the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation,and the other cases have no recurrence or metastasis.Dual J-tube was removed in 9 cases in the last follow-up,and the new bladder volume was estimated 300-350 ml,with residual urine of 0-43 ml and 19 ml of average.There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.Conclusions Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time.The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.
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Diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), specifically arising in ileal neobladder, is a rare neoplasm. We present an unusual case of Epstein–Barr virus (EBV)–positive DLBCL-CI arising within neobladder with detailed clinical, histological, and immunophenotypical features in an immunocompetent patient. An 88-year-old male was admitted for gross hematuria. He had undergone radical cystectomy and ileal neobladder 17 years ago for invasive bladder cancer. Computed tomography showed enhancing lesions on dome and posterior wall of neobladder with mucosal thickening and multiple enlarged retroperitoneal lymphadenopathies. Transurethralresection of neobladder lesion revealed the diffuse infiltration of large lymphoid cells which were positive for CD20, CD30, and multiple myeloma oncogen-1 with EBV-encoded small RNAs co-localizing, and diagnosis of EBV-positive DLBCL-CI was made. After multi-agent chemotherapy, the lesion disappeared. We suggest that clinicians should consider the possibility of DLBCL-CI in patients presented with hematuria during follow-up after bladder reconstruction.
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Idoso de 80 Anos ou mais , Humanos , Masculino , Linfócitos B , Cistectomia , Diagnóstico , Tratamento Farmacológico , Seguimentos , Hematúria , Inflamação , Linfócitos , Linfoma de Células B , Mieloma Múltiplo , RNA , Bexiga Urinária , Neoplasias da Bexiga UrináriaRESUMO
Objective@#To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder, and to summarize the experiences.@*Methods@#The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed. All patients were male, aged 33 to 77 years, with an average of 64.4 years. Body mass index ranged from 18.0 to 31.8 kg/m2, with an average of 23.2 kg/m2. One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor, with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma. No case underwent neoadjuvant therapy, and all cases were clinically staged as cT2a-3bN0-2M0. Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed. The specific procedures were described as follows. After bladder resection, the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve, with the proximal part retaining 15 cm lumen as the input loop, and the distal part of 40 cm ileum being folded in 1∶1 ratio. The folded intestinal segment was made into a allantoic sac by using a linear incision closure device, forming a "ρ" shape with the input loop, bilateral ureters and the input loop. Anastomosis of wall, distal end of allantoic and urethra was performed.Record the perioperative data such as operation time, estimated bleeding, postoperative recovery, complications, and follow-up results.@*Result@#All of the 11 cases underwent successfully operation, and no cases were transferred to open surgery. The operation time ranged from 320 to 440 minutes, with an average of 357.1 minutes. The estimated amount of bleeding ranged from 100 to 300 ml, with an average of 207.1 ml. The total time of intestinal tract procedure was 80-100 minutes, with an average of 89.3 minutes, and the time of allantoic preparation was 14-19 minutes, with an average of 16.1 minutes. The pain score was 2-5 points at 4 hours after operation, with an average of 3.8 points, and 1-4 points at 24 hours after operation, with an average of 2.3 points. Postoperative exhaust time ranged from 2.5 to 3.5 days, with an average of 3.0 days.Catheter removed 21 days after operation, with 9 cases of urinary incontinence, including mild in 6 cases, moderate in 2 cases and severe in 1 case, with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks. Postoperative hospital stay ranged from 7 to 13 days, with an average of 10.4 days. The drainage removal time was 4-11 days, with an average of 6.7 days. Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma, 3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma. The tumors invade the prostate in adenocarcinoma patient, with left (3/13) and right (1/9) positive lymph nodes. One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes, and the other cases were negative. The margin were negative in all patients. Pathological staging was pT2a-4aN0-2M0. Postoperative adjuvant chemotherapy with gemcitabine+ cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks, with an average of 17.4 weeks, the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation, and the other cases have no recurrence or metastasis. Dual J-tube was removed in 9 cases in the last follow-up, and the new bladder volume was estimated 300-350 ml, with residual urine of 0-43 ml and 19 ml of average. There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.@*Conclusions@#Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time. The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.
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Objective To evaluate changes of the urodynamics of extraperitoneal Studer orthotropic ileal neobladder after radical cystectomy.Methods Between July 2013 and October 2017,Retrospective analysis was performed on 58 bladder cancer patients.58 patients who underwent retrograde extraperitoneal approach of radical cystectomy and Studer orthotopic ileal neobladder.The patients were comprised of 56 male and 2 female patients with average age of 62 years.There were 9 cases of T1,26 cases of T2,20 cases of T3,and 3 cases of T4.All operations were completed by open suprapubic extraperitoneal approach,then entered the abdominal cavity.An ileal segment 50-55 cm long was isolated which was 25 cm proximal to the ileocecum.The 35-40 cm ileal segment was detubularized along its antimesenteric border.The anterior wall was folded forward with U-shaped and the edges were sutured to formed a neobladder.The proximal 15cm was reserved for the double isoperistaltic afferent limb.The lowest part of the neobladder was anastomosed with urethral stump,the peritoneum was closed at the mesentery,and the neobladder was completely placed extraperitoneal.Upper urinary tract function was examined by renal function test,enhanced CT,IVU or cystography.Uroflowmetry,urodynamic evaluation,diurnal and nocturnal continence were performed at 3,6,12,24 months following the surgery.Results After removed of the catheter,all patients were able to urinate through the urethra.The 3,6,12,24 month follow-up data of urodynamic were compared.The maximum neobladder capacity was[(378 ±66) vs.(381 ± 102)vs.(438 ± 75)vs.(472 ±96)] ml,the maximum flow rate [(10.2 ± 2.8) vs.(14.9 ± 4.3) vs.(16.4 ± 3.6) vs.(17.6 ± 2.1)] ml/s,maximum bladder pressure during filling was [(23.0 ± 4.6) vs.(21.7 ± 7.1) vs.(20.6 ± 6.4) vs.(18.8 ±6.3)] cmH2 O,the PVR was[(68.0 ± 33.2) vs.(36.2 ± 10.1) vs.(30.6 ± 11.9) vs.(14.0 t 9.6)] ml.There were significant differences between the 6-month and 12-month.There were no significant differences in the maximum bladder pressure during flowing [(38.6 ± 7.4) vs.(49.2 ± 6.8) vs.(58.4 ± 10.5) vs.(56.8 ± 7.4)] cmH2O.53 cases were followed up 12 months after surgery.Excellent daytime and nighttime continence was 98％ (52/53)and 83 ％ (44/53)in the first year.Mild unilateral hydronephrosis occurred in 2 cases 1 month after surgery.Blood electrolytes and renal function were within the normal range.1 case presented bilateral mild hydronephrosis 12 months after surgery,without bladder and ureter regurgitation.The blood electrolyte and renal function of the other patients were in normal range with no signs of ureteral stricture and upper urinary tract hydronephrosis.Conclusions Extraperitoneal Studer orthotopic ileal neobladder reduced the interference of postoperative intraperitoneal intestinal tract on neobladder function.Postoperative patients have a smooth urination,a safe pressure during the storage period.The urination period,and the function of day and night urinary control is close to normal physiological characteristics.
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Objective To report the technique and effect of robotic-assisted laparoscopic radical cystectomy (RARC) totally intracorporeal orthotopic ileal neobladder in female bladder cancer patient.Methods A consecutive series of 5 female patients with urothelial carcinoma of the bladder,who underwent RARC,bilateral pelvic lymph node dissection and intracorporeal orthotopic W-shaped ileal neobladder by an experienced robotic surgeon,were included in the retrospective study,from December 2017 to March 2018.Data were reviewed retrospectively.The patients aged 51-68 years old,with mean age 62.2 years,and BMI was 13.6-22.8 kg/m2,mean 18.1 kg/m2.The specimens were removed from the vagina.A 40 cm bowel segment with detubularisation was chosen for the W-shaped neobladder which was constructed manually.All patients resumed ambulation on postoperative 2 days and resumed oral feeding on postoperative day 3.The single-J stents and catheter were removed 12 days and 2 weeks after operation,respectively.Results All operation were performed successfully.The average operation time was 384.2 min (ranging 355-428 min) with mean estimated blood loss of 620 ml (ranging 150-1 800 ml).And the average number of dissected lymph nodes was 15 (ranging 10-20).The neobladder and urethra anastomotic leakage was observed in one patient who was healed after 2 weeks indwell catheter.Small bowel obstruction occurred in one case 3 weeks after operation and recovered after conservative treatment.The daytime urinary control was good,and 1 cases had urinary incontinence at night (follow up 4-7months,median:5.5months).No recurrence or metastasis was observed during routine follow-up.The imaging showed the good morphology of the upper urinary tract and the new bladder.Conclusions Our initial experience supports the feasibility and advantage of totally intracorporeal orthotopic W-shaped ileal neobladder following RARC in female patient with bladder cancer.It is worth to further verification in a large sample with longer follow-up.
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Objective To compare perioperative outcomes and complications between intracorporeal and extracorporeal orthotopic ileal neobladder after laparoscopic radical cystectomy (LRC) from one center.Methods We retrospectively analysis patients' clinical and follow-up data who underwent laparoscopic radical cystectomy (LRC) in our hospital from January 2011 to May 2017,of whom 25 cases underwent intracorporeal orthotopic ileal neobladder (ICIN) and 20 cases underwent extracorporeal orthotopic ileal neobladder (ECIN).The patients' characteristics,perioperative data,postoperative pathological results,postoperative complications and oncologic outcomes were compared and analyzed.The mean age of ECIN group was (59.9 ± 10.5)years,mean BMI was (24.7 ±3.3)kg/m2,the ASA level was less than Ⅱ in 19 cases and level Ⅲ in 1 case,the mean preoperative CCI was 4.5 ± 1.6,3 patients got preoperative neoadjuvant chemotherapy.The mean age of ICIN group was (59.0 ± 9.8) years,mean BMI was (25.3 ±4.3)kg/m2,the ASA level was less than Ⅱ in 25 cases and no level Ⅲ,mean preoperative CCI was 4.0 ±1.3,3 patients got preoperative neoadjuvant chemotherapy.There was no statistical difference between the two groups in patients' characteristics.All operations were performed under general anesthesia.After LRC was accomplished,an additional 12 mm trocar was placed 1 cm crania to the pubic symphysis for EndoGIA in ICIN group.An ileal segment 60 cm long was isolated 25 cm proximal to the ileocecum.The continuity of the small bowel was restored with side to side anastomosis.The proximal 10 cm was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb,and the remaining proximal 10 cm ileal segment was reserved for the left isoperistaltic afferent limb.Then,the remaining length of the 40 cm ileal segment was detubularized along its antimesenteric border.The anterior wall of the neobladder was folded forward and the free edges were sutured to achieve a spherical configuration.After single J ureteric stents were inserted into the ureters,the urethra and ureters were sutured with neobladder successively.For ECIN,the ileal segment is removed via a midline laparotomy below the umbilicus 5-10 cm.The construction method of neobladder was the same with ICIN group.Results All 45 cases were successfully operated.There was no statistical difference between ICIN group and ECIN group in operation time [(374.2 ± 74.6) min vs.(360.3 ±83.6)min,P =0.557] and extraction time of pelvic drainage tube[(12.5 ±5.9)d vs.(11.8 ±4.5)d,P =0.686].Patients in the ICIN group had less intraoperative blood loss [(186.0 ± 140.3)ml vs.(272.0 ±110.7) ml,P =0.030],shorter oral intake time [(4.2 ± 2.2) d vs.(6.1 ± 1.6) d,P =0.002],shorter postoperative hospital stay [(13.7 ± 4.2) d vs.(19.9 + 7.6) d,P =0.001].There was no significant difference in the early postoperative complications (P =0.345).The median follow-up time of ICIN group and ECIN group were 30 months and 52.5 months,respectively.The day-time and night-time continence rate were 97.4％ and 86.8％ respectively in the first year after surgery without significant difference.A total of 6 patients suffered distant metastasis,of whom 4 patients suffered multiple metastases,1 case bone metastases and 1 case pelvic lymph node metastasis.Seven patients died,five of whom died of tumor recurrence or metastasis.There was no statistical difference between the two groups in cancer specific survival rates (P =0.644) and recurrence free survival rates (P =0.981).Conclusions Comparing with extracorporeal orthotopic ileal neobladder,intracorporeal orthotopic ileal neobladder has advantages of less blood loss and faster intestinal function recovery,without significantly increased operative time and complications.No significant difference was found in the function of neobladder and oncological outcomes.Randomized controlled trial with large sample and long-term follow-up is needed to verify the advantages of intracorporeal neobladder construction.
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Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.
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Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.
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Objective To investigate the surgical methods and experience of laparoscopic radical cystectomy and orthotopic ileal neobladder for invasive bladder cancer. Methods The clinical data of 14 patients with invasive bladder cancer underwent laparoscopic radical cystectomy and orthotopic ileal neobladder were collected retrospectively during March 2011 and October 2014. Results The 13 patients with invasive bladder cancer were successfully completed laparoscopic radical cystectomy and orthotopic ileal neobladder. 1 case was treated with laparotomy because of unsatisfactory surgery ifeld caused by excessive tumor bleeding. Twelve cases of the urethra-neobaldder anastomosis were completed through the abdominal incision, while for the other 2 cases, the anastomosis was done under the laparoscope, 2 cases were performed neovesicourethral anastomosis using single-needle running sutures through laparoscopy. The median operative time was 444 minutes, the mean intraoperative blood loss was 490 ml. Postoperative pathologic results conifrmed that 12 cases were bladder transitional cell carcinoma (1 case with partial squamous cell carcinoma) and 2 cases with bladder adenocarcinoma. No severe complication occurred except for 2 cases of urinary leakage and 1 case of urinary incontinence. Patients were followed up for 6-56 months,within which 3 patients were died of distant metastasis, 1 case was detected with intracranial metastasis, 1 case was found with urethra-vesical anastomotic stenosis while cured after urethrotomy. Ten cases were well recovered and the mean volume of the neobladder was 300 ml. Conclusions Laparoscopic radical cystectomy and orthotopic ileal neobladder have the advantage of better therapeutic effects, safety, minimal invasion and rapid recovery, which are the preferred therapeutic methods for invasive bladder cancer.
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Objective To investigate the surgical skills of pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder.Methods From October 2014 to September 2016,37 patients with locally advanced bladder cancer(cT2-3 N0-2 Mo)were diagnosed,including 29 males and 8 females,Their age ranged from 52 to 71 years old.According to preoperative cystoscopy,pathological diagnosis and bladder enhanced CT and other examination,25 patients were staged as cT2,12 cases were staged as cT3.25 cases of them were primary tumors,who underwent pure robotic-assisted radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.First,bilateral lymph nodes were dissected.And the ureter was explored and dissected to the outer wall of the bladder.Then,we ligated the superior artery of bladder and expose the seminal vesicle,vas deferent duct.The DV fascia was opened to expose the posterior wall of prostate.Incise was performed along the both sides of the bladder and prostate fascia to maintain the vascular nerve bundle until the tip of prostate.The urethra was cut off and then the bladder was remove.We used Endo-GIA to cut 30-35 cm ileum and construct U-shaped bladder.The anastomosis between ureter and neo-bladder and the anastomosis between urethra and neo-bladder were performed.Perioperative and followup data were collected.Results The surgeries were successful in all 37 cases.The operation time ranged from 245 to 335 min,mean (285 ± 37) min.The mean intraoperative blood loss was (187 ± 56) ml (ranging 90-300 ml).The average postoperative hospital stay was (17 ± 2)days (ranging 15-20 days).Postoperative intestinal function recovery time ranged from 1.3 to 2.2 days,mean (1.7 ± 0.4) days.Surgical margins were all negative.Lymph node positive rate was 21.6％ (8/37).After 1 nonth,22 cases achieved complete continence.After 3 months,35 cases get fully self-control urination,8 cases have noctual incontinence.Postoperative follow-up ranged from 6 to 24 months,no recurrence or distant metastasis was found in this study.After 6 months,cystoscopy showed no obvious formation of bladder stones.Neo-bladder capacity ranged from 270 to 350 ml.The urodynamic examination showed bladder pressure was maintained between 19 and 25cm H2O.Conclusions Pure robotic-assisted radical cystectomy can achieve better bladder resection,better remaining of urethral and neurovascular bundles and good control of urinary continence after operation.Endo-GIA assisted orthotopic U-shaped ileal bladder need shorter intestinal tract and cause less influence to the intestinal function.The neo-bladder shape is more regular,simple doing,earn shorter operation duration,less bleeding,quick recovery,which is a safe and effective surgical approach.
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Objective To assess the perioperative safety and postoperative function of the pure 3-dimensional laparoscopic cystectomy and urinary diversion (P3DLC-UD).Methods From April 2014 to July 2015,P3DLC-UD was performed in 15 patients diagnosed with the bladder cancer in our center (orthotopic ileal neobladder for 8 cases and ileal conduit for 7 cases).Perioperative data,postoperative continence and overall survival rate were retrospectively analyzed.Results Fifteen patients underwent P3DLC-UD successfully as planned,with 8 patients underwent orthotopic ileal neobladder and 7 patients underwent ileal conduit.In neobladder group,the operative time were 300-600mmin (mean 428 min),estimated blood loss were l 00-400ml (mean 210mml),and dissected lymph nodes were 11-29 (mean 16).One patient required blood transfusion (800ml) and one patient was diagnosed of constipation.The patients were followed up for a median period of 10 months (3-15 months).The renal function was normal with serum creatinine of 36.4-99.0 μ mol/L (mean 77.3 μmol/L).One patient died of intestinal obstruction and 8 patients had no recurrence in neobladder group.As to postoperative continence,only 2 patients demanded 1 pad at daytime,while all patients needed 1 pad at nighttime.In ileal conduit group,the operative time were 300-390 min (mean 354 min),estimated blood loss were 50-400ml (mean 190ml),and dissected lymph nodes were 9-41 (mean 22),while 9-41 (mean 19) lymph nodes were got for all 15 cases.Two patients were diagnosed with urinary infection after the surgery.The patients were followed up for a median period of 5 months (1-9 months).The renal function was normal with serum creatinine of 36.4-74.0 μmol/L (mean 60.8 μmol/L).One patient died of cerebral infarction,and 1 patient found distant metastases in lung and died of cancer after chemotherapy during the follow-up period.There were no recurrent tumors of the other 5 patients in ileal conduit group.Conclusions P3DLC-UD is safe and feasible.More extensive,longer-term randomized trials are required to comprehensively assess the appropriateness and potential of this technique.
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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.
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Objective To summary the experience of laparoscopic cystectomy ileal conduit (Bricker) and orthotopic ileal neo‐bladder (Hautmann) and compare the short‐term efficacy of the two types of urinary diversion for invasive bladder cancer . Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical cystectomy from 2010 to 2014 was performed ,74 of them accepted ileal conduit ,and 30 of them accepted orthotopic ileal neobladder .The general clinical data ,postop‐erative recovery ,postoperative complications and Oncology feature were analyzed and compared between the two groups .Results There was no demonstrable difference was found in operation time ,blood loss ,intraoperative blood transfusion rate ,the number of removed lymph node ,average hospital stay ,specimens positive margin rate and postoperative pathology results between the two groups (P>0 .05) .But there were significant difference in postoperative intestinal function recovery time[(4 .2 ± 1 .4)d ,(5 .3 ± 2 .2)d] ,(P=0 .002) ,and the complication rates 31 .9% (23 cases)vs .53 .3% (16 case) ,P=0 .043 .After 6 months ,the daytime and nighttime urinary control were 76 .9% ,57 .7% ,after 12 months ,the daytime and nighttime urinary control increased to 90 .9% , 81 .8% .2 cases(7 .7% ) were diagnosed with recurrence or metastasis during follow‐up in Hautmann group ,while 9 cases(14 .1% ) were diagnosed with recurrence or metastasis in Bricker group .Conclusion Two kinds of surgical procedures both have the similar therapeutic effect ,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients .
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Objective To compare the recent clinical efficacy between ileal neobladder and orthotopic ileal neobladder.Methods The clinical data of 62 patients with bladder cancer who were performed with cystectomy plus urinary diversion were retrospectively analyzed.Among them,32 patients were performed with orthotopic ileal neobladder(orthotopic ileal neobladder group)and 30 patients were performed with ileal neobladder(ileal neobladder group).The operation time,intraoperative bleeding,intestinal function recovery time,hospital stay,early postoperative complications were compared between two groups.Results All the patients were successful,and there was no operative deaths occurred.There was no significant difference in the postoperative intestinal function recovery time between two groups(P ＞ 0.05).The operation time,intraoperative bleeding,hospital stay in orthotopic ileal neobladder group was higher than that in ileal neobladder group [(463.59 ± 50.24)min vs.(436.07 ± 44.91)min,(1081.16 ± 320.49)ml vs.(867.53 ± 224.61)ml,(46.88 ± 4.67)d vs.(20.37 ± 5.24)d],but the incidence of early postoperative complications in orthotopic ileal neobladder group was lower than that in ileal neobladder group [25.0％(8/32)vs.53.3％(16/30)],and there were significant differences between two groups(P ＜0.05).Conclusions Two kinds of urinary diversion surgical urinary diversion are clinically more mature manner,in clinical practice.Clinicians should be based on the patient's comprehensive situation,combined with the clinical experience to select the most appropriate surgical procedures.
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Objective To investigate the effect of early nursing intervention on severe complication of radical cystectomy and orthotopic ileal neobladder.Methods A total of 30 patients undergoing radical cystectomy with orthotopic ileal neobladder were randomly divided into the intervention group and the control group with 15 cases in each group,the control group received routine nursing,while the intervention group received psychological counseling,health education,sufficient preoperative preparation,postoperative strict tube care,nutritional support according to the serious complications after operation.The postoperative complications,indwelling time of tubes,hospitalization days between two groups were compared.Results Serious complications rate after surgery of the intervention group was lower than that in the control group.The indwelling time of tubes,length of stay in the intervention group were less than those of the control group,the two groups had significant difference.Conclusions Early predictive nursing intervention can reduce compli-cations rate after radical cystectomy and ileal neobladder,shorten the hospitalization time and improve the success rate of operation.
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Objective To evaluate the urodynamic parameters of W shape orthotopic ileal neobladder during a 36-month follow-up post-operatively.Methods Forty-five consecutive patients underwent radical cystectomy and W shape ileal neobladder substitution for muscle-invasive bladder cancer were recruited.Follow-up and urodynamic evaluation were performed at 12 and 36 months after surgery.Cystourethrography,ultrasonography,IVU and renal function test were performed during the follow-up.Results Of the 45 patients,3 were dead during the follow-up because of cancer-related causes.When comparing to the 12-and 36-month urodynamic parameters,Qmax,MCC,compliance,end-filling pressure,peak flow pressure and PVR respectively were 15.6 ± 2.3 ml/s and 14.9 ± 1.9 ml/s,588.0 ± 264.6 ml and 561.0 ±197.4 ml,27.6±8.4 ml/cm H2O and 29.5 ±1.7 ml/cm H2O,24.4 ±5.2 cm H2O and 33.0 ±6.8 cmH2O,60.7 ±18.0 cm H2O and 79.9 ±28.2 cm H2O,83.5±24.4 ml and 80.4 ±26.8 ml.At early and late evaluation,daytime continence rate was 90％ and 94％,night continence rate was 48％ and 74％.Conclusions Orthotopic W shape ileal neobladder was proven to maintain an adequate capacity and low pressure during a 36-month period of follow-up.The urodynamic results support this urinary diversion as a valid treatment option for muscle-invasive bladder cancer.