AB172. Laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs: initial experience

OBJECTIVE: To describe the surgical technique and initial experience of laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs. METHODS: From January 2014 to December 2015, 13 patients who underwent a new method of orthotopic ileal neobladder intracorporeally after laparoscopic radical cystectomy were retrospectively reviewed at our institution. To construct the neobladder, an ileal segment 60 cm long was isolated approximate 25 cm proximally to the ileocecum. The proximal 20 cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10 cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10 cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40 cm ileal segment was detubularized along its antimesenteric border for the reservoir. The demographics, perioperative and follow-up data were analyzed for the study. RESULTS: All procedures were successfully performed without open conversion. The mean operative time was 372 minutes (range, 280–470 minutes), and mean neobladder construction time was 229 minutes (range, 180–298 minutes). The mean estimated blood loss was 150 mL (range, 100–400 mL). The mean time to flatus was 4 days (range, 3–12 days). No major complications occurred within 30 days. CONCLUSIONS: Laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs is safe and feasible. However, larger series with long term follow-up are required to prove its superiority.