Female robotic-assisted laparoscopic radical cystectomy with intracorporeal orthotopic W-shaped ileal neobladder / 中华泌尿外科杂志

ABSTRACT

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,median5.5months).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.