title: Laparoscopic-assisted radical cystectomy with U-shaped orthotopic ileal neobladder constructed using nonabsorbable titanium staples.
abstract: 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.
authors.affiliation: Andros Hospital Urológico de Brasília, Brasilia, Brazil. sidneyabreu@hotmail.com
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Abreu
authors.forename: Mardhen B
authors.initials: MB
authors.lastname: Araújo
authors.forename: Rômulo A
authors.initials: RA
authors.lastname: Silveira
authors.forename: Rommel P
authors.initials: RP
authors.lastname: Regadas
authors.forename: Danilo G
authors.initials: DG
authors.lastname: Pinheiro
authors.forename: Frederico I
authors.initials: FI
authors.lastname: Messias
authors.forename: Renato S
authors.initials: RS
authors.lastname: Argollo
authors.forename: Glauco A
authors.initials: GA
authors.lastname: Guedes
authors.forename: João Batista C
authors.initials: JB
authors.lastname: Gadelha
authors.forename: Gilvan N
authors.initials: GN
authors.lastname: Fonseca
mesh_terms: 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*
chemical_list: D014025:Titanium