The first laparoscopic radical cystectomy was reported by Parra et al. in 1992 in a 27-year-old woman with recurrent bladder atrophy due to paraplegia and infection. In 1995, laparoscopic radical cystectomy was first used to treat invasive bladder cancer. With the continuous improvement of laparoscopic instruments and the accumulation of experience as well as the improvement of technology, especially the increasing number of laparoscopic radical prostate cancer cases, urologists have accumulated a lot of experience in pelvic surgery, making laparoscopic radical cystectomy available to more and more urologists. 53 cases of laparoscopic radical cystectomy were reported in 2003 at the American Urology Congress. In 2006, the International Registry of Laparoscopic Radical Cystectomy showed that 13 units performed more than 500 laparoscopic radical cystectomies, while the actual number of cases performed is much higher than the registry figures, and more than 100 cases have been reported from a single center abroad.
Because radical cystectomy requires simultaneous urinary diversion, the operation is complex and time-consuming, and different surgical approaches are chosen for urinary diversion at different times and in different units. Currently, there are 2 main types of laparoscopic urinary diversion: (1) radical cystectomy and urinary diversion are done completely laparoscopically, but this procedure is time-consuming and requires 4-5 Endo-GIAs to restore intestinal continuity intraoperatively, and a 3-cm incision is still needed to remove the specimen after surgery. (2) Radical cystectomy is completed laparoscopically, then a small incision is made in the abdominal wall, open surgery for urinary diversion or open surgery for neobladder formation, then the neobladder is placed into the abdominal cavity, the abdominal wall incision is sutured, and a neobladder-urethral anastomosis is made laparoscopically. The latter approach was adopted by our group, mainly considering that the first approach is time-consuming, while the second approach can be completed by making an incision of about 7 cm in the abdominal wall for the rest of the operation after cystoprostatectomy, which saves time and is less traumatic to the patient. The incision in the abdominal wall is closed and the laparoscopic anastomosis between the ureter and the urethra is completed in this way.
Whether laparoscopy is suitable for such a complex procedure as radical cystectomy is still controversial, and its long-term results in treating tumors need to be further observed. A group of data showed that 86 cases of bladder cancer underwent laparoscopic radical cystectomy with a follow-up period of 1 to 73 months, with a mean of 25 months, and their tumor outcomes were similar to those of open surgery. Laparoscopic radical cystectomy is now considered to have the following advantages: small surgical incision, about 7 cm; laparoscopic resection of the bladder prostate helps to deal with important structures in the deep pelvic floor, such as the deep dorsal penile vein complex, the penile neurovascular bundle and the urethral sphincter, in a meticulous and precise manner, so that every step of the operation is completed under a clear view; less intraoperative bleeding, no blood transfusion or less blood transfusion; reduced surgical trauma, reduced postoperative pain and faster recovery; short intraoperative intestinal tube exposure time, which is conducive to postoperative intestinal function recovery and reduction of postoperative intestinal adhesions, while laparoscopic surgery better protects the patient’s immune system and reduces the postoperative infection rate. The average intraoperative bleeding in this group of 23 cases was 311 ml, and only one case was transfused intraoperatively and postoperatively, and the recovery time of intestinal function was 2-3 days after surgery. Because of the rich vascularity of the ligaments on both sides of the bladder and the passage of the central branch of the dorsal penile vein in the pubic prostatic ligament, all foreign countries advocate the use of linear tissue incision sutures for treatment, which is very expensive, and we use ultrasonic knife and bipolar electric knife to cut off the tissue during surgery, which has exact hemostatic effect and low cost. It is believed that with the accumulation of experience and the advancement of laparoscopic operation technology, laparoscopic radical cystectomy is expected to become an effective treatment for invasive bladder cancer without distant metastasis.