Laparoscopic radical cystectomy with total intracorporeal ileal neobladder: first case report in Thailand

Radical cystectomy (RC) remains the gold standard for muscle-invasive, organ-confined urothelial carcinoma (UC) of the bladder Recently, laparoscopic surgery has been used increasingly by urologists as a minimally invasive procedure to treat neoplasms of the pelvic organs. The present study aimed to report technical aspects of the experience of treating Thailand first case of RC with bilateral pelvic lymphadenectomy and ileal neobladder under the totally intracorporeal laparoscopic technique.

A 67-year-old Thai male patient presented with intermediate-grade muscle- invasive UC of the bladder with negative metastatic workout. Laparoscopic radical cystectomy and pelvic lymphadenectomy were performed using 5 abdominal ports. Hemostasis was performed with bipolar forceps and vascular clips. The authors performed U-shape ileal neobladder and anastomosis using the completely intracorporeal laparoscopic technique. The operative time was 10 hours, the estimated blood loss was 1,000 ml, and there were no serious complications. The ureteric stents were removed after the 7th day, the tube drain was removed after the 10th day, and the Foley catheter was removed after the 21th day. The post-operative pathologic report indicated intermediate-grade muscle-invasive UC and free resection margin.

The authors initial experience in Laparoscopic Radical cystectomy with totally intracorporeal ileal neobladder demonstrated that it was a feasible treatment modality. However more cases are required in the future to confirm its efficacy and improve laparoscopic technical performance in the treatment of organ-confined UC.