Laparoscopic radical cystectomy with orthotopic gastric neobladder: technique and initial outcomes.

OBJECTIVES

To report our operative technique and initial outcomes of laparoscopic radical cystectomy (LRC) and external orthoptic gastric neobladder.

METHODS

Since 2003, nine patients have undergone laparoscopic radical cystectomy with orthotopic gastric neobladder at our institution. The specimen is extracted through a 6-cm vertical minilaparotomy incision above the umbilicus. The gastric neobladder was constructed as our open technique using the part of stomach body and antrum with the pedicle of gastroepiploic vascular bundle through the site of specimen retrieval. The operative data, complications and follow-up functional data were analyzed.

RESULTS

The mean operative time was 365 min (300-450). Mean blood loss was 520 ml (200-1,500) and four patients (44.4%) required blood transfusion. In all cases no conversion to open surgery was necessary. The length of stay was 17 days and the total complication rate was 55.6% (five cases). All patients were free of recurrence at a mean follow-up of 22 months (3-48). The day and night incontinence rate was 11.1 and 44.4%, respectively. At 6 months after operation, urodynamic evaluations indicated a larger capacity, low pressure urinary reservoir.

CONCLUSIONS

Laparoscopic radical cystectomy with orthotopic gastric neobladder is a feasible intervention. The external construction of the gastric neobladder using the part of stomach body and antrum is quick and safe. With precise and increased operative technique, the LRC with orthotopic gastric bladder may be a good choice for urinary diversion. However, the larger samples, long-term compared studies with bowel diversions are required to evaluate this new technique.