Intracorporeal Laparoscopic Y-Pouch Urinary Diversion

Abstract

Introduction: The purpose of this study is to describe the intracorporeal laparoscopic Y-pouch urinary diversion in patients with muscle invasive bladder cancer. Materials and Methods: The operation was performed in three patients with muscle invasive bladder tumor. Percutaneous nephrostomies were placed bilaterally to all patients preoperatively. After entering the abdomen and creating pneumoperitoneum, cystoprostatectomy was performed. All steps of the procedure, including the urinary diversion, were made entirely laparoscopically. Step 1: Ileal segment selection. Approximately 45–50 cm of ileum, 25 cm proximally to the ileocecal valve, was selected and folded. The tip of the folded segment was opened and an anastomosis between the bowel and the urethra was performed. Step 2: Y-pouch formation. The bowel segment that was chosen for the pouch was isolated and the continuity of the intestine was restored with endoGIA staplers. The folded segment was stabilized with sutures and was opened longitudinally with ultrasonic scissors. Then, the pouch was formed with sutures on the posterior and anterior surface. The latter task can also be performed using endoscopic staplers. Step 3: Double-J insertion. Guidewires are guided in the ureters with the use of a percutaneous endoscopic surgery needle. The Double-Js are inserted over the guidewires after the removal of the needle. The left ureter was not transposed to the right side. Step 4: Implantation of ureters. The ureters were spatulated and implanted in end to end fashion in the cephalad part of each side (horn) of the pouch. Results: All three surgeries were completed in 4.5–5 h without any intraoperative complication or need for blood transfusion. Only one patient had fever postoperatively (Clavien Grade I). The pouches have a capacity of 300–450 cc. One patient has mild day and nighttime incontinence. The remaining two have no daytime incontinence and one of them uses one pad during the nighttime. Conclusions: Intracorporeal laparoscopic Y-pouch urinary diversion is a safe and feasible procedure for experienced urologists and provides satisfactory postoperative functional results. No competing financial interests exist. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 9 mins 4 secs The video was first presented to WCE 2016 in Cape Town, South Africa, November 8–12, 2016.