Cardoso Andreia, Anacleto Sara, Tinoco Catarina Laranjo, Araújo Ana Sofia, Capinha Mariana, Pinto Luís Borges, Coutinho Aparício, Tavares Catarina, Marques Vera, Mota Paulo, Mendes Miguel, Oliveira Carlos, Torres João Pimentel, Carvalho-Dias Emanuel
Department of Urology, Hospital de Braga, Braga, Portugal.
Urol Res Pract. 2024 Oct 21;50(3):203-207. doi: 10.5152/tud.2024.23230.
Radical cystectomy (RC) with ileal conduit (IC) remains a main treatment for muscle-invasive bladder cancer (MIBC). Laparoscopy in this multistage surgery is quite demanding, so laparoscopic RC (LRC) with intracorporeal IC (IIC) is a technically exceptional procedure. We aim to simplify it, demonstrating our technique, step-by-step. We present a 4-port LRC with IIC and Bricker uretero-ileal anastomoses. The main difference is the immediate and complete posterior dissection, similar to the "Montsouris approach" for prostatectomy.
A 70-year-old man with a 5 cm MIBC was subjected to our demonstrated procedure.
The postoperative period was uneventful. Diet and ambulation: 2 days. Single-J stents removal: 4 weeks. MIBC N0 was confirmed. At 24 months, the patient is well, without complications (namely hydronephrosis or disease recurrence).
LRC with IIC is demanding and requires laparoscopic expertise. However, if performed in a standardized fashion, as demonstrated through this case, and considering our center's experience, it seems feasible and safe with 4-port and standard material without a significant operative time increase, nor oncological or functional compromise.
根治性膀胱切除术（RC）联合回肠膀胱术（IC）仍是肌层浸润性膀胱癌（MIBC）的主要治疗方法。在这种多阶段手术中，腹腔镜手术要求颇高，因此腹腔镜根治性膀胱切除术（LRC）联合体内回肠膀胱术（IIC）是一项技术要求极高的手术。我们旨在简化该手术，逐步展示我们的技术。我们介绍一种采用IIC和Bricker输尿管-回肠吻合术的四孔LRC。主要区别在于直接且完全的后入路解剖，类似于前列腺切除术的“蒙苏里方法”。
一名患有5厘米MIBC的70岁男性接受了我们展示的手术。
术后恢复顺利。饮食和活动：术后2天。单J管拔除：4周。确诊为MIBC N0。24个月时，患者情况良好，无并发症（即肾积水或疾病复发）。
LRC联合IIC要求较高，需要腹腔镜手术专业知识。然而，如本病例所示，如果以标准化方式进行，并考虑到我们中心的经验，采用四孔和标准材料进行该手术似乎可行且安全，不会显著增加手术时间，也不会造成肿瘤学或功能方面的损害。
