LAPAROSCOPIC RADICAL CYSTECTOMY WITH A Y-SHAPE NEOBLADDER, ASSISTED BY 5 CM INCISION
J.B. Mendes1, M.T. Tanaka1, C. A. Barreira2, E. F. Pacagnan1, M. R. S. S. B. Mendes3 , A. S. Tanaka1
1Master Clínica, Cascavel, Brazil, 2Uroclin, Cascavel, Brazil, 3Unioeste, Cascavel, Brazil
Introduction: Radical cystectomy with urinary diversion represents a great challenge for the laparoscopic surgeon, due to its complexity and the lack of standardization concerning the best way to perform it.
Method: A 62-year-old male patient with clinical staging T2b bladder transitional cell cancer, and ureterohydronephrosis in the right side, underwent a radical cystectomy with ileal neobladder diversion, at a Trendelenburg position and five port-sites. Both ureters were completely dissected at the pelvic region, and divided near the bladder. The prostate and seminal vesicles were approached to perform a radical prostatectomy. The bladder vascular pedicles were clipped. The specimen was removed through a small Phannenstiel. By open technique, a detubularized Y-shape neobladder was built and both uretero-y-arm anastomosis were performed, leaving a ureteral stent in. The laparoscopic technique resumed, after placing the neobladder intra-abdominally, to perform the uretra-neobladder anastomosis. Both neoblader Y-arms were anchored onto the lateral peritoneum with sutures. The mesentery defects were also sutured. The cavity was drained and a bladder indwelling Foley catheter left in for a month.
Result: The surgery lasted 570 minutes and was uneventful, with minimal bleeding and post operative pain. A month later, a cystogram showed a good reservoir with no contrast leakage. The hospital stay was 10 days.
Conclusion: Laparoscopic radical cystectomy is a feasible and provides advantages to the patient. The value of using staples and the incision assistance during this procedure will be evaluated by time.