Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: The initial 2 cases

Objectives. To present the initial 2 patients who underwent laparoscopic ra dical cystoprostatectomy, bilateral pelvic lymphadenectomy, and ileal condu it urinary diversion, with the entire procedure performed exclusively by in tracorporeal laparoscopic techniques. Methods. Two male patients, 78 and 70 years old, with muscle-invasive, orga n-confined, transitional cell carcinoma of the urinary bladder underwent th e procedure. The entire procedure, including radical cystoprostatectomy, pe lvic node dissection, isolation of the ileal loop, restoration of bower con tinuity with stapled side-to-side ileoileal anastomosis, retroperitoneal tr ansfer of the left ureter to the right side, and bilateral stented ileouret eral anastomoses were all performed exclusively by intracorporeal laparosco pic techniques. Free-hand laparoscopic suturing and in situ knot-tying tech niques were used exclusively. Results. The surgical time was 11.5 hours in the first patient and 10 hours in the second. The respective blood loss was 1200 mt and 1000 mt. In both patients, ambulation resumed on postoperative day 2, bower sounds on day 3, and oral intake on day 4; the hospital stay was 6 days. Narcotic analgesia comprised 108.3 mg and 16.5 mg of morphine sulfate equivalent, respectivel y. Pathologic examination revealed pT4N0M0 (prostate) and pT2bN0M0 transiti onal cell carcinoma of the bladder with the surgical margins negative for c ancer in both patients. No intraoperative or postoperative complications oc curred in either patient. Conclusions. To our knowledge, this is the initial report of laparoscopic r adical cystoprostatectomy with intracorporeal ileal conduit urinary diversi on. We believe that with further experience and refinement in the operative technique, laparoscopic radical cystoprostatectomy with ileal conduit urin ary diversion may become an attractive treatment option for selected candid ates with localized muscle-invasive bladder cancer. UROLOGY 56: 26-30, 2000 . (C) 2000, Elsevier Science Inc.