Laparoscopic orthotopic ileal neobladder

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Orthotopic ileal neobladder is a preferred continent urinary diversion after radical cystectomy for muscle-invasive bladder cancer.
• Current techniques often involve open surgery or laparoscopic approaches with extracorporeal components.

Purpose of the Study:

• To report the initial experience of a completely intracorporeal laparoscopic orthotopic ileal neobladder construction in a porcine model.
• To evaluate the feasibility, safety, and functional/anatomical outcomes of this novel technique.

Main Methods:

• Laparoscopic cystectomy and orthotopic ileal neobladder creation were performed entirely intracorporeally in 12 pigs.
• Ileal segments of varying lengths were used, with reconstruction via stapled anastomosis.
• Anastomoses for urethroileal and ileoureteral connections were created using laparoscopic free-hand suturing.
• Postoperative evaluation included biochemical, radiological, urodynamic, and histological assessments.

Main Results:

• Successful completely intracorporeal laparoscopic neobladder construction in all 12 animals without open conversion.
• Mean operative time was 5.4 hours with minimal blood loss.
• Excellent functional outcomes with adequate neobladder capacity (mean 420 mL) and low pressures (< or = 20 cm H2O).
• No anastomotic strictures or leaks observed; histological examination showed excellent healing.

Conclusions:

• Laparoscopic construction of an orthotopic neobladder is feasible and safe.
• The technique yields excellent anatomical and functional results, comparable to open surgery.
• This minimally invasive approach holds promise for imminent clinical application in suitable patients.