[Application of modified single port laparoscopic radical cystoprostatectomy and orthotopic ileal neobladder].
OBJECTIVE
To evaluated the feasibility and therapeutic effect of laparoscopic-endoscopic single-site surgery (LESS) for radical cystoprostatectomy and orthotopic ileal neobladder.


METHODS
Between November 2008 and August 2009, 8 male patients with bladder cancer underwent modified single port laparoscopic cystoprostatectomy and orthotopic ileal neobladder with a home-made multichannel port made up of two stretchable rings and a surgical glove with trocars and valves attached to its fingers. A 4 - 5 cm midline incision was made in lower abdomen and the multichannel port placed into this incision. Laparoscopic instrument was extended through the multichannel port. Another port was placed at the umbilicus site for laparoscope. The investigators performed the modified single port transperitoneal technique neobladder extracorporeally and urethro-pouch anastomosis under laparoscopy with a slipknot running suture technique. The perioperative and postoperative data were collected and analyzed prospectively.


RESULTS
In all cases, no conversion into conventional laparoscopic or open surgery was necessary. The mean operative duration, including extended lymph node dissection, was 399 min (range: 355 - 455 min). Mean estimated blood loss was 154 ml (range: 90 -210 ml). The mean postoperative hospital stay was 15 d (range: 14 - 18 d). No peri-operative mortality was reported. One case had delirium 2 days postoperatively and there was no port-related complication. The pathological report confirmed surgical margins were tumor-free for all cases. The average number of removed lymph node was 20. The mean follow-up period was 6.1 months (range: 2.0 -10.0 months). All patients remained disease-free until the last follow-up.


CONCLUSIONS
With a reduction of 4 ports, modified single port laparoscopic radical cystectomy with orthotopic ileal neobladder is technically feasible with a low complication rate. Our initial outcome is encouraging, but additional work and a further follow-up are warranted to critically compare the oncological outcome with open surgery.
Huang
Jian
J
Department of Urology, Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. yehjn@yahoo.com.cn
Lin
Tian-Zin
TZ
Xu
Ke-Wei
KW
Han
Jin-Li
JL
Ye
Feng
F
Huang
Hai
H
Jiang
Chun
C
Zhang
Cai-Xia
CX
Yao
You-Sheng
YS
Xie
Wen-Lian
WL
Liu
Hao
H
D000368:Aged; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D001749:Urinary Bladder Neoplasms / Q000601:surgery*