Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, China.
Investig Clin Urol. 2022 Sep;63(5):523-530. doi: 10.4111/icu.20220156.
With the increasing application of laparoscopic or robot-assisted radical cystectomy, a reliable and promising method is needed for reducing postoperative complications. We describe the short-term outcomes of totally extraperitoneal laparoscopic radical cystectomy (TELRC) with extraperitoneal pelvic lymph node dissection (EPLND) and extraperitoneal ileal orthotopic neobladder (EION) techniques.
From January 2020 to December 2021, we performed TELRC and EPLND with EION in 72 patients in our center. The accompanying video highlights our novel techniques. The patients' demographic data, intraoperative data, and perioperative complications were collected, and short-term oncological and functional results are reported.
All procedures were technically successful without conversion to open surgery. The patients' mean body mass index was 26.22±5.71. Median age was 57.51±12.34 years. Average hospital stay was 13.78±4.62 days. Median intraoperative blood loss was 112.92±88.56 mL. No blood transfusion was needed during the operations and only one blood transfusion was performed during the perioperative period. Mean operating time was 259.44±49.84 minutes. Average cost was US$9,875.71±1,873.08. Postoperative short-term complications included short-term ileus (n=3), infection (n=13), leakage of urine (n=11), and lymph fistula (n=7). One late complication of unilateral vesicoureteral anastomotic stenosis occurred. The mean follow-up was 13.42±8.77 months, and no patient developed local or systemic recurrence. The short-term follow-up and small cohort of patients limited our evaluation of outcomes.
TELRC with PLND and EION was technically feasible and clinically promising, with a reduced potential harm of postoperative complications. Long-term follow-up and a larger cohort of patients are needed for further study.
随着腹腔镜或机器人辅助根治性膀胱切除术的应用日益增多，需要一种可靠且有前途的方法来降低术后并发症。我们描述了完全腹膜外腹腔镜根治性膀胱切除术（TELRC）联合腹膜外盆腔淋巴结清扫术（EPLND）和腹膜外回肠原位新膀胱术（EION）技术的短期结果。
自 2020 年 1 月至 2021 年 12 月，我们在中心为 72 例患者实施了 TELRC 和 EPLND 联合 EION。伴随的视频突出了我们的新方法。收集了患者的人口统计学数据、术中数据和围手术期并发症，并报告了短期肿瘤学和功能结果。
所有手术均成功完成，无中转开放手术。患者的平均体重指数为 26.22±5.71。中位年龄为 57.51±12.34 岁。平均住院时间为 13.78±4.62 天。中位术中出血量为 112.92±88.56ml。术中无需输血，仅在围手术期输了一次血。平均手术时间为 259.44±49.84 分钟。平均费用为 9875.71±1873.08 美元。术后短期并发症包括短期肠梗阻（n=3）、感染（n=13）、尿漏（n=11）和淋巴瘘（n=7）。发生单侧输尿管吻合口狭窄的迟发性并发症。平均随访时间为 13.42±8.77 个月，无患者出现局部或全身复发。随访时间短且患者数量少限制了我们对结果的评估。
TELRC 联合 PLND 和 EION 技术上可行，临床上有前途，降低了术后并发症的潜在危害。需要长期随访和更大的患者队列来进一步研究。
