A Combined Technique for Radical Cystoprostatectomy and Orthotopic Ileal Neobladder

Abstract

After anatomical and surgical studies on cadavers we developed a combined technique for radical cystoprostatectomy with orthotopic ileal neobladder labelled M.I. La. N. (Minimally Invasive Laparoscopic Neobladder). The aim of this technique is to combine the advantages of open and laparoscopic surgery. Between June 2001 and July 2002, 6 men aged 65 to 72 underwent combined radical cystoprostatectomy with orthotopic ileal neobladder for organ-confined bladder cancer. The M.I. La.N. consists of 3 steps: 1) laparoscopic radical cystoprostatectomy and bilateral pelvic lymph node dissection; 2) external partial fashioning of the neobladder and side-to-side bowel anastomosis; 3) laparoscopic lower urinary tract reconstruction. The mean time of the overall procedure was 425 minutes (range 360 to 510). Mean estimated blood loss was 312 mL (range 220 to 440). Mean hospital stay was 8.1 days (range 7 to 9). Histopathology revealed 1 pT1N0 G3 plus carcinoma in situ (Cis), 1 pT2aN0 G3 plus Cis, 4 pT2bN0 G2-3. The surgical margins were tumor free. At the time of analysis (October 2003) the mean follow-up is 18.1 months (range 15 to 21). Two patients respectively stage pT1N0 + Cis and pT2bN0 G2-3 died for metastatic disease at 20 and 18 months after the operation. One patient stage pT2aN0 plus Cis died for unrelated causes free from disease after 16 months from the procedure. The remaining 3 patients are alive and free from disease. The combined technique for radical cystoprostatectomy with orthotopic ileal neobladder (“M.I. La. N.”) can reproduce open surgery. Moreover, it provides an anatomic approach, familiar to most urologist and anatomical landmarks are easy to follow. In our opinion, the combined approach does not reduce the advantages of laparoscopy. We know that this technique may require a long learning curve and it is still a pioneristic procedure. A strict follow up is necessary to evaluate the oncological outcome that is still unpredictable for the low number of treated patients and for biology of bladder cancer.