AB014. Laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs: initial experience

Objective: To describe the surgical technique and initial experience of laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs.

Materials and Methods: From January 2014 to Jun 2015, 11 patients underwent a new method of orthotopic ileal neobladder intracorporeally after laparoscopic radical cystectomy at our institution. To construct the neobladder, an ileal segment 60 cm long was isolated approximate 25 cm proximally to the ileocecum. The proximal 20 cm of the ileal segment was divided into 2 parts for bilateral isoperistaltic afferent limbs. The proximal 10 cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10 cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40 cm ileal segment was detubularized along its antimesenteric border for the reservoir. The demographics, perioperative and follow-up data were analyzed for the study.

Results: All surgeries were successfully performed without open conversion. The mean operative time was 365 minutes, and mean neobladder construction time was 246 minutes. The mean estimated blood loss was 190 mL. The mean time to flatus was 4 days. Postoperative complications occurred in 4 patients, including 2 cases of incomplete bowel obstruction, 1 case of urinary tract infection, and 1 case of incision hernia.

Conclusions: Laparoscopic radical cystectomy with the novel urinary diversion is safe, feasible and reproducible with encouraging outcomes. Larger series with long term follow-up are required to prove its superiority.

Keywords: Laparoscopic; cystectomy; intracorporeal; orthotopic; neobladder