title: Complete ileal neobladder intracorporeal construction with standard sutured technique and novel technology.
abstract: OBJECTIVE
  We compared the surgical efficacy and efficiency of a completely suture based procedure with a novel entero-urethral anastomosis device and an EndoGIA stapler to create an ileal neobladder.
  
  
  METHODS
  Two groups of 7 pigs each were survived for 8 weeks. In group 1 the neobladder was constructed using a U-shaped segment of ileum sealed with the stapler. The entero-urethral anastomosis was created with a novel sutureless anastomosis device. All other procedures were completed with standard intracorporeal suturing techniques. In group 2 animals completely intracorporeal sutured technique was used. Total procedure, and enteroenteric, ileal neobladder, uretero-enteric and entero-urethral anastomosis times were recorded. Cystograms done immediately postoperatively, at 2 weeks and at sacrifice to evaluate the newly constructed system were rated from 0-no leakage to 3-severe leakage.
  
  
  RESULTS
  In group 1 vs 2 the overall procedure, and enteroenteric, ileal neobladder, uretero-enteric and entero-urethral anastomoses were completed in 285.3, 32.3, 58.8, 54.2 and 5.5 vs 350.1, 29.9, 139.1, 58.0 and 46.3 minutes, respectively. In groups 1 and 2 the average postoperative cystogram rating was 0.83 and 1.6, respectively (p = 0.63). At 2 weeks and at sacrifice cystograms showed no extravasation in either group. The overall surgical procedure, pouch creation and entero-urethral anastomosis were statistically briefer in group 1 (p = 0.036, 0.01 and 0.039, respectively). Average survival in groups 1 and 2 was 30 (range 4 to 56) and 41 days (range 1 to 56), respectively (p = 0.36). All animals had voiding complications within 1 week after ureteral and urethral catheters were removed. One neobladder ruptured in group 1.
  
  
  CONCLUSIONS
  Combining stapled ileal neobladder construction and the entero-urethral anastomosis device significantly decreases operative time, pouch creation and urethral anastomoses.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Evren
authors.initials: E
authors.lastname: Durak
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hruby
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.forename: Preston
authors.initials: P
authors.lastname: Sprenkle
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mirabile
authors.forename: Franzo
authors.initials: F
authors.lastname: Marruffo
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D004867:Equipment Design; D005260:Female; D007082:Ileum / Q000601:surgery*; D013536:Suture Techniques; D013552:Swine; D014521:Urethra / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods*