Initial experience of pure 3-Dimensional laparoscopic cystectomy and urinary diversion

Abstract

Objective To assess the perioperative safety and postoperative function of the pure 3-dimensional laparoscopic cystectomy and urinary diversion(P3DLC-UD). Methods From April 2014 to July 2015, P3DLC-UD was performed in 15 patients diagnosed with the bladder cancer in our center (orthotopic ileal neobladder for 8 cases and ileal conduit for 7 cases). Perioperative data, postoperative continence and overall survival rate were retrospectively analyzed. Results Fifteen patients underwent P3DLC-UD successfully as planned, with 8 patients underwent orthotopic ileal neobladder and 7 patients underwent ileal conduit. In neobladder group, the operative time were 300-600min (mean 428 min), estimated blood loss were 100-400ml (mean 210ml), and dissected lymph nodes were 11-29 (mean 16). One patient required blood transfusion (800ml) and one patient was diagnosed of constipation. The patients were followed up for a median period of 10 months (3-15 months). The renal function was normal with serum creatinine of 36.4-99.0 μmol/L (mean 77.3 μmol/L). One patient died of intestinal obstruction and 8 patients had no recurrence in neobladder group. As to postoperative continence, only 2 patients demanded 1 pad at daytime, while all patients needed 1 pad at nighttime. In ileal conduit group, the operative time were 300-390 min (mean 354 min), estimated blood loss were 50-400ml (mean 190ml), and dissected lymph nodes were 9-41 (mean 22), while 9-41 (mean 19) lymph nodes were got for all 15 cases. Two patients were diagnosed with urinary infection after the surgery. The patients were followed up for a median period of 5 months (1-9 months). The renal function was normal with serum creatinine of 36.4-74.0 μmol/L (mean 60.8 μmol/L). One patient died of cerebral infarction, and 1 patient found distant metastases in lung and died of cancer after chemotherapy during the follow-up period. There were no recurrent tumors of the other 5 patients in ileal conduit group. Conclusions P3DLC-UD is safe and feasible. More extensive, longer-term randomized trials are required to comprehensively assess the appropriateness and potential of this technique. Key words: Pure 3-dimensional laparoscopy; Bladder cancer; Orthotopic ileal neobladder; Ileal conduit