Complete laparoscopic ileal cystoplasty.
BACKGROUND
Laparoscopic enterocystoplasty provides a minimally invasive approach to bladder augmentation in the patient with a neurogenic bladder. In previously published reports, portions of the procedure were performed extracorporeally. We report our technique of complete intracorporeal laparoscopic enterocystoplasty.


METHODS
Important elements of the operation include (a) preoperative evaluation of patient compliance and videourodynamic studies; (b) cystoscopic placement of externalized ureteral stents; (c) transperitoneal placement of five radially dilating trocars; (d) identification of the cecum; (e) proximal mobilization of ileum sufficient for pelvic placement; (f) measurement of ileal length with segment of precut vessel loop; (g) vertical cystotomy after incising peritoneum and entering the space of Retzius; (h) ileal division and side-to-side anastomosis using endoscopic gastrointestinal anastomosis staplers; (i) detubularization and freehand intracorporeal suturing into a U-shaped configuration; (j) fixing ileal patch at the 6 and 11-o'clock positions; (k) completion of ileal-bladder anastomosis in quadrants with running sutures; (l) irrigation of bladder and placement of a closed suction drain in the pelvis; and (m) cystogram 4 weeks postoperatively.


CONCLUSIONS
Pure laparoscopic enterocystoplasty is an advanced procedure that is technically feasible and yields excellent results, but has unproven benefits. We perform the entire operation intracorporeally with traditional instruments and do not rely on suturing devices or extracorporeal knots. Additional experience and technological developments may result in routine laparoscopic urinary augmentation and continent diversion.
Elliott
Sean P
SP
Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143, USA.
Meng
Maxwell V
MV
Anwar
Haroon P
HP
Stoller
Marshall L
ML
D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery