Laparoscopic transverse hemicystectomy with ileocystoplasty in a porcine model

Background and Purpose: The ideal replacement for bladder tissue is yet to be described, although multiple alternatives have been studied. Currently, enterocystoplasty, despite its limitations, is considered the gold standard for bladder augmentation. This study evaluated the feasibility, safety, an d morbidity of laparoscopic ileocystoplasty in a large-animal model. Materials and Methods: In eight minipigs, laparoscopy was performed using f our ports. A segment of ileum was delivered through a 3-cm umbilical incisi on and detubularized and refashioned using standard open surgical technique . Laparoscopic hemicystectomy was then performed, followed by laparoscopic suturing of the ileal patch to the bladder. The bladder was drained with a Foley catheter, but no pelvic drain was placed. All animals were followed f or for a minimum of 3 months. Preoperative and postoperative evaluation inc luded measurement of bladder capacity, ultrasound imaging of the kidneys, b lood counts, and serum electrolyte and creatinine measurements. Two of the animals were sacrificed at 3 months and one at 6 months, and the bladders w ere harvested. Results: Eight animals underwent ileocystoplasty without intraoperative or postoperative complications. The average operating and anastomosis time was 250 minutes and 96 minutes, respectively. All animals had normal preoperat ive blood values that remained normal during follow-up. Bladder capacity de creased initially to 71% of the baseline volume and then increased to 83% a nd 117% at 3 and 6 months. One of three animals sacrificed was noted to hav e a right midureteral stricture. Conclusions: We developed a reliable laparoscopic technique for ileocystopl asty that may extend the advantages of laparoscopy, including better cosmes is and reduced risk of postoperative adhesions, to bladder augmentation.