Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: The initial 5 cases

Purpose: We present our experience with the first 5 patients who underwent radical cystectomy with bilateral pelvic lymphadenectomy and continent urin ary diversion (rectal sigmoid pouch) performed with an intracorporeal lapar oscopic technique at our center. Materials and Methods: There were 3 males and 2 females 59 to 65 years old with organ confined, muscle invasive transitional cell carcinoma of the bla dder who underwent surgery. The procedure included pelvic lymph node dissec tion, radical cystectomy with prostate or uterus and tubal structures, crea tion of the rectal sigmoid pouch and bilateral stented antireflux implantat ion of the ureters into the pouch. Freehand laparoscopic suturing and in si tu knot tying techniques were used exclusively. The mobilized specimens wer e removed in an endoscopy bag via the rectum or vagina. Laparotomy was not required. Results: Operating time was 6.9 to 7.9 hours (median 7.4) and blood loss wa s 190 to 300 ml. (median 245). None of the 5 patients none needed blood tra nsfusion. Oral intake was started on hospital day 3, ureteral stents were r emoved on day 8 and the pouch catheter was removed on day 9. The hospital s tay was 10 days for all cases. Histopathological examination of the specime ns revealed stage pT1 G3 urothelial carcinoma in case 1, pT2b G2 in cases 2 and 3, pT3a G2 in case 4 and pT3aG3 in case 5. The lymph nodes and resecti on margins were tumor-free. No intraoperative or postoperative complication s were observed. Conclusions: To our knowledge, this is the first series of laparoscopic rad ical cystectomy with intracorporeal continent urinary diversion (rectal sig moid pouch), and our results are promising. With more experience and improv ement of the surgical technique, laparoscopic radical cystectomy with conti nent urinary diversion may become an alternative surgical method for treati ng select patients with localized muscle invasive bladder cancer.