Initial experience of pure 3-Dimensional laparoscopic cystectomy and urinary diversion / 中华泌尿外科杂志

ABSTRACT

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.