Laparoscopic-assisted radical cystectomy with U-shaped orthotopic ileal neobladder constructed using nonabsorbable titanium staples.
BACKGROUND
Recently, nonabsorbable staples have been safely used in a variety of urologic open and laparoscopic extirpative and reconstructive procedures. We report the surgical steps of our technique of U-shaped orthotopic ileal neobladder created with titanium staples.


METHODS
Using stay stitches, a 45 to 50-cm ileal segment is arranged in a U shape with two segments of approximately 20 cm and an afferent limb of 5 or 10 cm. An opening is made at the lowest point of the U-ileal segment on its antimesenteric border. The jaws of the 80 x 3.5-mm nonabsorbable mechanical stapler are accommodated within the bowel loop and fired twice, bringing together and detubularizing approximately 15 cm of each arm of the U. To complete the pouch detubularization, another small opening is made at the bottom of the chimney on its medial border. After this, a third nonabsorbable mechanical stapler had its jaws introduced through this opening and through the open end of the bowel segment on the right side and the stapler is fired, completing the U pouch. Subsequently, the open ends of the U segment and the opening made at the base of the afferent limb are closed with absorbable running sutures.


CONCLUSIONS
Our technique is feasible and may represent an alternative to expand the spectrum of continent urinary reservoirs that could be expeditiously created with nonabsorbable staples. Continued surveillance is mandatory to determine the lithiasis-inducing potential of these titanium staples within the urinary tract.
Abreu
Sidney C
SC
Andros Hospital Urológico de Brasília, Brasilia, Brazil. sidneyabreu@hotmail.com
Araújo
Mardhen B
MB
Silveira
Rômulo A
RA
Regadas
Rommel P
RP
Pinheiro
Danilo G
DG
Messias
Frederico I
FI
Argollo
Renato S
RS
Guedes
Glauco A
GA
Gadelha
João Batista C
JB
Fonseca
Gilvan N
GN
D015653:Cystectomy; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D013528:Surgical Staplers; D017792:Surgical Stapling; D014025:Titanium; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods*
D014025:Titanium