Total laparoscopic gastrocystoplasty: experimental technique in a porcine model.
OBJECTIVE
Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model.


METHODS
We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy.


RESULTS
Mean total operative time was 5.2 (range 3.5 - 8) hours: 84.5 (range 62 - 110) minutes for the gastric dissection, 56 (range 28 - 80) minutes for the gastric suturing, and 170.6 (range 70 to 200) minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram.


CONCLUSIONS
Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.
Romero
Frederico R
FR
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. frederico.romero@gmail.com
Trapp
Claudemir
C
Muntener
Michael
M
Brito
Fabio A
FA
Kavoussi
Louis R
LR
Jarrett
Thomas W
TW
D000714:Anastomosis, Surgical; D000818:Animals; D015653:Cystectomy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D034421:Sus scrofa; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*