Laparoscopic assisted radical cystoprostatectomy with Y-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples through a 5 cm Pfannensteil incision.
BACKGROUND
We performed a laparoscopic radical cystoprostatectomy followed by constructing a Y-shaped reservoir extra-corporeally with titanium staples through a 5-cm muscle-splitting Pfannenstiel incision.


METHODS
Upon completion of the extirpative part of the operation, the surgical specimen was entrapped and removed intact through a 5-cm Pfannenstiel incision. Through the extraction incision, the distal ileum was identified and a 40 cm segment isolated. With the aid of the laparoscope, the ureters were brought outside the abdominal cavity and freshened and spatulated for approximately 1.5-cm. Bilateral double J ureteral stents were then inserted up to the renal pelvis and the ureters were directly anastomosed to the open ends of the limbs of the neobladder. Following this, the isolated intestinal segment was arranged in a Y shape with two central segments of 14 cm and two limbs of 6 cm. The two central segments were brought together and detubularized, with two sequential firings of 80 x 3.5 mm and 60 x 3.5 mm non-absorbable mechanical stapler (Multifire GIA--US Surgical) inserted through an opening made at the lowest point of the neobladder on its anti-mesenteric border. The neobladder was reinserted inside the abdominal cavity and anastomosed to the urethra with intracorporeal laparoscopic free-hand suturing.


CONCLUSIONS
Although this procedure is feasible and the preliminary results encouraging, continued surveillance is necessary to determine the lithiasis-inducing potential of these titanium staples within the urinary tract.
Abreu
Sidney C
SC
Urological Hospital of Brasília, Brazil. sidneyabreu@hotmail.com
Messias
Frederico I
FI
Argollo
Renato S
RS
Guedes
Glauco A
GA
Araujo
Mardhen B
MB
Fonseca
Gilvan N
GN
D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D003558:Cystoscopy; D006801:Humans; D007082:Ileum / Q000637:transplantation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D011859:Radiography; D013528:Surgical Staplers; D014025:Titanium / Q000627:therapeutic use; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016476:Urinary Reservoirs, Continent
D014025:Titanium