title: Laparoscopic radical cystectomy with orthotopic ileal neobladder: a report of 85 cases.
abstract: OBJECTIVE
  The preliminary results of laparoscopic radical cystectomy in 85 patients are presented in this study. The functional and oncologic outcomes of this procedure in these patients are discussed.
  
  
  METHODS
  Between December 2002 and May 2006, we performed 85 laparoscopic radical cystectomies with orthotopic ileal neobladder for bladder cancer in 77 men and 8 women. A 5-port transperitoneal approach was applied. The standard bilateral pelvic lymphadenectomy was performed first, then radical cystectomy was completed laparoscopically. The construction of the ileal neobladder and the anastomosis of ureter-neobladder were performed extracorporeally. The neobladder was anastomosed to the urethral stump under laparoscopy. A nerve-sparing procedure was performed for eight patients.
  
  
  RESULTS
  The median operative time was 320 min, and the median blood loss was 280 mL. Conversion to open surgery was not necessary in any of the patients. The average time to oral intake after operation was 3.9 days. There were no perioperative mortalities. The complication rate was 14.1% (12/85), including such complications as three uretero-pouch anastomotic strictures, one vesicourethral anastomotic stricture, one pouch-vaginal fistula, one colonic pouch fistula, one ileo-pouch fistula, three ileus, one pneumonia, and one pyelonephritis. The daytime continence rate was 91.2%, and the nighttime continence rate was 82.4% at 6 months postoperatively. The neobladder capacity was about 343 mL. Surgical margins were tumor free for all patients. Of the eight patients who underwent a nerve-sparing procedure, four patients had potency for intercourse. During a follow-up period of 1 to 41 months (average 21.3 months), three patients had local recurrence, one patient had trocar site seeding, and five patients had distant metastasis, of whom four died.
  
  
  CONCLUSIONS
  Laparoscopic radical cystectomy with extracorporeal formation of a neobladder is a feasible procedure with low morbidity and acceptable neobladder function. Long-term follow-up is needed to confirm the oncologic outcomes.
authors.affiliation: Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. yehjn@yahoo.com.cn
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
authors.forename: Tianxin
authors.initials: T
authors.lastname: Lin
authors.forename: Kewei
authors.initials: K
authors.lastname: Xu
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
authors.forename: Chun
authors.initials: C
authors.lastname: Jiang
authors.forename: Jinli
authors.initials: J
authors.lastname: Han
authors.forename: Yousheng
authors.initials: Y
authors.lastname: Yao
authors.forename: Zhenghui
authors.initials: Z
authors.lastname: Guo
authors.forename: Wenlian
authors.initials: W
authors.lastname: Xie
authors.forename: Xinbao
authors.initials: X
authors.lastname: Yin
authors.forename: Caixia
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery; D016476:Urinary Reservoirs, Continent; D014554:Urination