Objective: To introduce the initial experience of 13 cases of
laparoscopic radical cystectomy and construction of orthotopic
T pouch ileal neobladder, and evaluation of oncological and
functional results of this procedure.
Methods: From August 2005 through July 2009, 13 patients
underwent radical cystectomy and standard lymphadenectomy followed by construction of orthotopic T pouch ileal neobladder
by 5 cm mini-laparostomy for muscle invasive bladder cancer.
Data were analyzed according to procedure time, blood loss,
transfusion, number of dissected lymph nodes, peri-operative
complications, morphology and function of upper urinary tract,
and status of urinary continence.
Results: Mean operating time was 6.3 (5-8) hrs, estimated
blood loss 480 (100-800) mL, transfusion 133 (0-400) mL,
lymph nodes dissected 16 (8-22), no peri-operative death, perioperative
complications was found in 15.4% (2/13) including
1 urine leak at neobladder-urethra junction which was managed
by drainage and 1 urine leak at ureter-neobladder junction
which was repaired. Complete daytime continence rate was
84.6% (11/13); complete night-time continence rate 46.1%
(6/13) and 1 pad in 30.8% (4/13). No reflux into afferent
limb of neobladder was observed by cystography. Temporary
dilation of upper urinary tract was observed in 23.1% (3/13) in
45 days post-operative, then disappeared spontaneously, Serum
creatinine remained in normal range in all patients. With 24 (16-63)
months follow-up, 7.7% (1/13) died of myocardial infarction
55 months after surgery, 92.3% (12/13) survived without local
relapse or distal metastasis.
Conclusions: With intermediate follow-up, the oncological
and functional results are encouraging after laparoscopic radical
cystectomy and construction of orthotopic T pouch ileal
neobladder by mini-laparostomy; The anti-reflux mechanism
is effective to protect the morphology and function of upper