Laparoscopic Radical Cystectomy With Intracorporeal Orthotopic Neobladder Reconstruction: An Initial Experience of Modified Studer Reconstruction Techniques

ABSTRACT

This study aimed to describe the initial experience of laparoscopic radical cystectomy (LRC) with total intracorporeal urinary diversion (ICUD). The procedure was performed in a male patient using a 5-port transperitoneal approach. Radical cystoprostatectomy and bilateral pelvic lymphadenectomy were performed laparoscopically. A 40-cm segment of the ileum 20 cm from the ileocecal junction was then isolated, and ileo-ileal continuity was restored using Endo- GIA staplers. Bilateral ureteroileal anastomoses were individually performed using the modified Studer chimney. Running urethroileal anastomosis was performed at the midpoint of the remaining distal 30 cm of the ileal segment. The distal 30 cm of the isolated ileal segment was detubularized, and a modified Studer neobladder was constructed. The total operative time was 465 minutes, and the estimated blood loss was 890 mL. The patient resumed ambulation on postoperative day 2, and oral liquids were resumed on postoperative day 8. The surgical margins of bladder specimens were negative for cancer. LRC with ICUD performed completely intracorporeally was feasible. Large-scale studies are needed to define these benefits and corroborate these findings.