[Efficacy and safety of transvaginal assisted total intracavitary orthotopic neobladder surgery for female urothelial carcinoma of the bladder].

A retrospective analysis was conducted on the data of 9 female patients with bladder urothelial carcinoma who underwent robot-assisted radical cystectomy and transvaginal-assisted total intracavitary orthotopic neobladder surgery in the Department of Urology, the Second Hospital of Tianjin Medical University from January 2022 to August 2025. Perioperative indicators (overall operation time, neobladder construction time, intraoperative blood loss, and recovery time of intestinal function) were observed postoperatively. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score of the chief surgeon was evaluated and the learning curve was drawn using the cumulative sum (CUSUM) method. Postoperative complications within 30 days (using the Clavien-Dindo classification) and the recovery of urinary control function at 1, 6, and 12 months after surgery were followed up. The tumor control and other indicators were evaluated every 3 months within 2 years and every 6 months from the third year after surgery. The age of patients was (51.3±11.0) years, body mass index was (19.5±4.2) kg/m², and the American Society of Anesthesiologists score was 1-2 points. The overall operation time was (342.5±58.3) min, the neobladder construction time was (121.7±22.6) min, the intraoperative blood loss was (150±50) ml, the time to first postoperative exhaust was (1.74±0.63) d, and the NASA-TLX score of the chief surgeon was (66.3±5.5) points. The CUSUM learning curve of neobladder construction time and NASA-TLX score was divided into the learning stage (cases 1-5) and the proficient stage (cases 6-9). Four patients had early postoperative complications (within 30 days after surgery), all of which were Clavien-Dindo grade I-II. At 6 months after surgery, 8 patients had complete dryness during the day and night, and 1 patient had chronic urinary retention. The prognosis was good, with no tumor recurrence or metastasis. The cancer-specific survival (CSS) was 100%. In this study, the transvaginal natural orifice-assisted total intracavitary orthotopic neobladder surgery showed a promising clinical application prospect. The preliminary results indicated that this technique was feasible, had a short learning curve, and had good short-term tumor control and urinary control recovery effects.