TOTALLY INTRACORPOREAL LAPAROSCOPIC RADICAL CYSTECTOMY WITH MODIFIED ILEAL PADUA NEOBLADDER RECOSTRUCTION IN MALE. SURGICAL APPROACH EVOLUTION AND OUTCOMES
Aim of the present study is to report our 1 year experience on the results of totally intracorporeal laparoscopic radical cystectomy (LRC) with orthotopic urinary diversion in 5 Caucasian males. The LRC procedure is started by establishing a pneumoperitoneum and the insertion of two 5 mm, two 10 mm trocars and one Hasson 12 mm trocar. Radical cysto-prostatectomy is performed using the 5 mm ligasure. Bilateral standard lymphadenectomy was performed. Urinary diversion is configured as a modified ileal padua neobladder reconstruction selecting 40 centimeters of the ileum. 25 cm are used for the left arm and 15 cm are used for the right arm. The posterior plate of the neobladder is made using a 45mm long automatic stapler. The remaining neobladder configuration is made with absorbable 3-0 running suture.
The mean operative time was 414 ± 27 minutes, the mean blood loss was 249.69 ± 95.59 milliliters, the mean length of hospital stay was 9.62 ± 2 days and the mean morphine requirement was 3.54 ± 0.7 days.
The overall complication rate was 60% (3/5). However, the majority of the patients had minor complications with mini-invasive re-intervention needed.