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. 2021 Mar 30:13:2909-2915.
doi: 10.2147/CMAR.S288673. eCollection 2021.

A Novel Neobladder-Urethral Drag-and-Bond Anastomosis Technique During Laparoscopic Radical Cystectomy for Ileal Orthotopic Neobladder: Surgical Technique and Initial Research

Zhaojun Yu  1   2   3 , Jianbiao Huang  1   2   3 , Huanhuan Deng  1   3 , Zhihua Zeng  1 , Leihong Deng  4 , Xiangda Xu  1 , Haichao Chao  1 , Tao Zeng  1
Affiliations

A Novel Neobladder-Urethral Drag-and-Bond Anastomosis Technique During Laparoscopic Radical Cystectomy for Ileal Orthotopic Neobladder: Surgical Technique and Initial Research

Zhaojun Yu et al. Cancer Manag Res. .

Abstract

Purpose: To explore the application of the neobladder-urethral drag-and-bond anastomosis technique in laparoscopic radical cystectomy (LRC) with ileal orthotopic neobladder (IONB) reconstruction.

Patients and methods: This is a retrospective cohort study on a procedure performed by a single surgeon. From January 2014 to December 2018, we identified 43 male bladder cancer patients who received LRC with IONB reconstruction. These patients were divided into two groups, with 22 patients undergoing neobladder-urethral drag-and-bond anastomosis (NUDA) and 21 patients undergoing neobladder-urethral anastomosis under laparoscopy (NUAL). Anastomosis time, catheter removal time, postvoid residual (PVR), maximum urinary flow rate (Q-max), urine leakage and anastomotic stenosis were used to evaluate the simplicity and surgical effect of the two groups.

Results: Both groups demonstrated similar tumor characteristics. A significant difference in neobladder-urethral anastomosis time was found between the NUDA group and the NUAL group (14.6 ± 0.4 vs 70 ± 2.5 min, P<0.0001), and there was no significant difference in other characteristics.

Conclusion: The neobladder-urethral drag-and-bond anastomosis technique in LRC and IONB reconstruction, with its shorter learning curve, was easier and more convenient than neobladder-urethral anastomosis under laparoscopy.

Keywords: bladder cancer; drag-and-bond anastomosis; ileal orthotopic neobladder; laparoscopic radical cystectomy; neobladder-urethral anastomosis.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) A hole similar in diameter to that of a 20 Fr Foley catheter was created at the apex of the neobladder, and the anterior wall of the neobladder was sutured. The 20 Fr Foley catheter was inserted into the pelvis through the urethra. (B) Six to eight windings of 2–0 Mersilk were wrapped around the Foley catheter 0.5 cm distal to the catheter balloon and tied. The catheter was inserted into the neobladder through the hole at the apex. The hole with the catheter windings was sutured with 2–0 VICRYL at 6, 8, 10, 12, 2 and 4 o’clock intermittently. (C) The neobladder was secured to the Mersilk wound around the catheter with a 2–0 VICRYL suture. (D) The catheter balloon was inflated with 20 mL normal saline, and gentle traction was applied to the Foley catheter. The neobladder descended to the lowest position of the pelvic cavity along the direction of the catheter and naturally approached the urethra. The catheter was gently pulled outward with proper tension. Plain gauze was tied around the catheter and slid to the outer urethral orifice.
Figure 2
Figure 2
Operation chart: The hole of the neobladder was sutured intermittently with the catheter windings. (A and B) The needle piercing through the wall of the neobladder and coming out of the hole; (C) The needle passing through the catheter windings; (D–F) The suture being tied in a surgical knot.
Figure 3
Figure 3
The anastomotic area of the patient 3 months after surgery under cystoscopy. The two images (A, B) show that there was no anastomotic stricture or neoplasm in the anastomotic area, and the mucosa of the anastomotic area was smooth and flat.
See this image and copyright information in PMC

References

    1. Castillo OA, Vitagliano G, Vidal-Mora I. [Laparoscopic radical cystectomy. The new gold standard for bladder carcinoma?]. Arch Esp Urol. 2009;62(9):737–744. doi: 10.4321/s0004-06142009000900009.Spanish. - DOI - PubMed
    1. Zhong H, Shen Y, Yao Z, et al. Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation. Int Urol Nephrol. 2020;52(1):41–49. doi: 10.1007/s11255-019-02296-x - DOI - PMC - PubMed
    1. Pham KN, Sack BS, O’Connor RC, et al. V-Loc urethro-intestinal anastomosis during robotic cystectomy with orthotopic urinary diversion. Can Urol Assoc J. 2013;7(11–12):E663–E666. doi: 10.5489/cuaj.508 - DOI - PMC - PubMed
    1. Miki J, Yanagisawa T, Tsuzuki S, Kimura T, Kishimoto K, Egawa S. Improved technique for intracorporeal neobladder-urethral anastomosis in laparoscopic radical cystectomy. Int J Urol. 2017;24(4):330–331. doi: 10.1111/iju.13299 - DOI - PubMed
    1. Badawy AA, Saleem MD, El-Baset EA, Morsi ES. Decreasing operative time and incontinence rates in patients treated with radical cystectomy and urethral diversion: a prospective randomized trial using a new suturing device (CAPIO). Int Urol Nephrol. 2012;44(3):769–774. doi: 10.1007/s11255-011-0105-9 - DOI - PubMed