Objective To investigate the surgical method and clinical experience of laparoscopic radical total cystectomy.
Methods From July 2008 to March 2011, we performed laparoscopic radical total cystectomy on 15 patients with pathologically confirmed invasive metastatic cell carcinoma of the bladder. Among them, 13 were male and 2 were female, aged 64-80 years, with a mean of 65 years. Six of them underwent in situ ileal substitution cystectomy and nine underwent ureteral skin stoma. A 5-port transepithelial approach was used, and a standard bilateral pelvic lymph node dissection and radical cystectomy were performed first under complete laparoscopy. A 4-5 cm incision was made in the lower abdominal midline to remove the specimen. 9 older patients underwent ureteral skin ostomy, 6 underwent extracorporeal ileal neobladder construction and ureteral neobladder anastomosis, and laparoscopic neobladder-urethral anastomosis. 3 male patients underwent erectile nerve preservation. The surgical time, intraoperative bleeding, postoperative bowel function recovery time, complications and surgical outcomes were observed.
There were no serious postoperative complications such as intestinal fistula, anastomotic stricture and urinary fistula, no perioperative death, and KUB, IVU and surrogate cystogram showed good visualization of both kidneys 3 weeks after surgery. There was no ureteral camp reflux or obstruction, and the surrogate bladder was well filled with a volume of about 200 ml. The patient could recover urinary control within 4-6 weeks after surgery. Patients could completely control urination during the day, and two cases had occasional incontinence at night. Postoperative pathology confirmed that all 5 cases were multiple invasive bladder cancer, grade 2-3. There were varying degrees of infiltration in the muscular layer, and no tumor cell infiltration was seen in the tangential margins of the external bladder tissue and local lymph nodes. Conclusion Transabdominal laparoscopic total cystectomy is safe and feasible with clear visualization, which can significantly reduce surgical trauma, intraoperative bleeding, and small incision to remove the specimen. The construction of the urinary storage bladder and anastomosis of the ureter outside the body can reduce the operation time and intra-abdominal contamination. Postoperative recovery is fast and complications are few. With the improvement of instruments and technical proficiency, this procedure will become a promising method for total cystectomy.