title: An improved technique for bladder cancer: Pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder using titanium staples.
abstract: OBJECTIVE
  To report our experience with an improved technique of laparoscopic radical cystectomy (LRC) and orthotopic ileal neobladder reconstruction, evaluating the perioperative and pathological outcomes.
  
  
  METHODS
  We retrospectively reviewed the data of 56 cases who underwent radical cystoprostatectomy followed by construction of an orthotopic U-shaped ileal neobladder between August 2010 and December 2014. These data include intraoperative data, early and long-term postoperative complications, neobladder function, urinary continence and oncologic results. Also the key innovative procedure was introduced with details.
  
  
  RESULTS
  The median time of the overall procedure was 212 min. The median estimated blood loss was 171 ml. The median hospitalization time after the operation was 21 days. Complications included two cases of unilateral ureter-pouch anastomotic strictures, one case of bilateral ureteral stricture, three cases of vesicourethral anastomotic strictures and three cases of vesicourethral leakage. The mean maximum pouch capacity was 446 ± 32 ml, and pouch pressure at capacity was 18.1 ± 2.6 cm H2O. The Qmax was 14 ± 1.2 ml/s, and the mean postvoid residual was 25 ± 10 ml. There were 9 cases of night-time incontinence at 3 months post-operatively. Negative surgical margins of the bladder specimens were achieved in all patients. During a follow-up period of 3-44 months (average 32.6 months), local recurrence was found in two patients and distant metastasis was occurred in another 3 patients.
  
  
  CONCLUSIONS
  Our preliminary experience showed that pure LRC with nonabsorbable titanium staples assisted orthotopic U-shape ileal neobladder reconstruction is feasible based on perioperative data and oncologic features.
authors.affiliation: Department of Urology, Zhejiang Provincial People's Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, PR China. Electronic address: zjuwangs@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Urology, Zhejiang Provincial People's Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, PR China. Electronic address: qixiaolong001@sina.com.
authors.forename: X
authors.initials: X
authors.lastname: Qi
authors.affiliation: Department of Urology, Zhejiang Provincial People's Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, PR China. Electronic address: liufeng2408@sina.com.
authors.forename: F
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Urology, Zhejiang Provincial People's Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, PR China. Electronic address: zhengmin21@sina.com.
authors.forename: M
authors.initials: M
authors.lastname: Zheng
authors.affiliation: Department of Urology, Zhejiang Provincial People's Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, PR China. Electronic address: zhangdahong88@126.com.
authors.forename: D
authors.initials: D
authors.lastname: Zhang
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014025:Titanium; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent
chemical_list: D014025:Titanium
keywords: Bladder cancer; Orthotopic ileal neobladder; Pure laparoscopy; Radical cystectomy