Orthotopic ileal bladder substitution [CAMEY II] following radical cystectomy using the linear-cutter stapling device

ABSTRACT

To evaluate the safety, efficacy and potential benefits of using the linear-cutter staplers in the ileal reanastomosis and ileal pouch reconstruction following radical cystectomy in patients with invasive carcinoma of the urinary bladder. We performed radical cystectomy and orthotopic ileal bladder substitution [Camey II] procedure in 20 patients with invasive carcinoma of the urinary bladder. In 10 patients the linear-cutter stapling device was used for the ileo-ileal reanastomosis and reconstruction of the pouch, while in the other 10 patients, the standard hand-suturing technique was used. The operative time and blood loss from the time of mobilization of the ileal segment to the time just before urethral anastomosis were calculated. Using the linear cutter-stapler in the ileo-ileal reanastomosis and ileal pouch reconstruction, saved approximately 1-1.5 hours of the operative time as mil as significant reduction of blood loss during this period. The leakage rate and hospital stay were less in patients with stapled pouch, but since most leakages were from the urethro-ileal anastomosis, the method used had no direct influence. The use of linear cutter staples in ileal reanastmosis and orthotopic ileal bladder substitution following radical cystectomy reduces significantly the operative time and blood loss without increased morbidity. The main question remains whether this equalizes the high cost of stapling devices