Totally Intracorporeal Laparoscopic Radical Cystectomy with Detubularized Sigmoid Orthotopic Neobladder: Technique Description and Preliminary Outcomes

To describe our technique for totally intracorporeal laparoscopic radical cystectomy with detubularized sigmoid orthotopic neobladder (SONB) and to report its preliminary outcomes.

Between April 2023 and May 2025, eight male patients with pathologically confirmed muscle-invasive or bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer underwent nerve-sparing laparoscopic radical cystectomy, standard pelvic lymph node dissection, and totally intracorporeal laparoscopic SONB construction performed by a single surgeon. Demographic, perioperative, pathological, and functional data were collected retrospectively; preliminary outcomes are reported.

All procedures were completed successfully without conversion to open surgery. Median operative time was 502.5 minutes (interquartile range [IQR]: 424.5-636.3), and median estimated blood loss was 100 mL (IQR: 62-275). Surgical margins were negative in all patients. Daytime urinary continence was good in six patients and satisfactory in one; one patient had unsatisfactory daytime continence. Nighttime continence was good in four patients, satisfactory in three, and unsatisfactory in one. Erectile function recovered in four patients. Low-grade complications (Clavien-Dindo grade I-II) occurred in four patients; one patient experienced a high-grade complication (grade IIIb) consisting of a sigmoid neobladder-rectal fistula.

Totally intracorporeal laparoscopic radical cystectomy with detubularized SONB construction seems feasible in select patients, yet the observed event warrants caution. This approach may serve as a valuable alternative for select patients undergoing laparoscopic radical cystectomy. Longer follow-up is required to confirm oncological and functional durability.