Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model

D. Duane Baldwin, S. Duke Herrell, Jennifer A. Dunbar, C. Jung, Amy H. Nunnally, Richard L. Roberts, Jeffrey R. Leach, Dipen J Parekh, Elspeth M. McDougall

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background and Purpose: Laparoscopic radical cystectomy with orthotopic ileal neobladder creation is a technically challenging and lengthy surgical procedure. We present our experience with a simplified technique for laparoscopic cystectomy and neobladder creation in the porcine model. Materials and Methods: Ten female minipigs underwent a purely laparoscopic radical cystectomy with orthotopic ileal neobladder creation. Nine ureterointestinal anastomoses were performed using a simplified "dunk" technique, where the ureter was prolapsed 5 mm into the afferent limb and the periureteral tissue was secured to the bowel serosa with three superficial sutures. Six ureters were not stented, and three had indwelling stents inserted. In 11 ureters, the anastomosis was performed using a running mucosa-to-mucosa technique (three with stents, eight without stents). The Lapra-Ty suture clip (Ethicon Endosurgery, Cincinnati, OH) was used to secure the running sutures on the urethra, ureters, and neobladder. Animals were harvested at 3 to 8 weeks (mean 6.5 weeks) after surgery. Serology, static cystogram, intravenous urography, and gross and histopathologic evaluations were performed. Results: Of six unstented dunked ureterointestinal anastomoses, two (33%) were widely patent, two were strictured but patent, and two were completely obstructed. In the three stented ureters implanted using the dunk technique, one (33%) was widely patent, one was strictured, and one was completely obstructed. All ureterointestinal anastomoses performed with a mucosa-to-mucosa running anastomosis, whether stented (three ureters) or not stented (eight ureters), were widely patent. Lapra-Ty clip migration into the neobladder pouch caused urethral obstruction resulting in delayed bladder perforation in two animals. Conclusions: Laparoscopic cystectomy and ileal neobladder creation is technically feasible. Attempts to simplify the ureterointestinal anastomosis require further evaluation and modification. Stent placement appears to be unnecessary in the laparoscopic ureterointestinal anastomosis. Laparoscopic creation of the ileal neobladder remains a technically challenging procedure.

Original languageEnglish
Pages (from-to)307-312
Number of pages6
JournalJournal of Endourology
Volume17
Issue number5
StatePublished - Jun 1 2003
Externally publishedYes

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Cystectomy
Ureter
Swine
Stents
Mucous Membrane
Sutures
Surgical Instruments
Running
Urethral Obstruction
Miniature Swine
Serous Membrane
Urography
Urethra
Serology
Urinary Bladder
Extremities

ASJC Scopus subject areas

  • Urology

Cite this

Baldwin, D. D., Herrell, S. D., Dunbar, J. A., Jung, C., Nunnally, A. H., Roberts, R. L., ... McDougall, E. M. (2003). Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model. Journal of Endourology, 17(5), 307-312.

Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model. / Baldwin, D. Duane; Herrell, S. Duke; Dunbar, Jennifer A.; Jung, C.; Nunnally, Amy H.; Roberts, Richard L.; Leach, Jeffrey R.; Parekh, Dipen J; McDougall, Elspeth M.

In: Journal of Endourology, Vol. 17, No. 5, 01.06.2003, p. 307-312.

Research output: Contribution to journalArticle

Baldwin, DD, Herrell, SD, Dunbar, JA, Jung, C, Nunnally, AH, Roberts, RL, Leach, JR, Parekh, DJ & McDougall, EM 2003, 'Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model', Journal of Endourology, vol. 17, no. 5, pp. 307-312.
Baldwin DD, Herrell SD, Dunbar JA, Jung C, Nunnally AH, Roberts RL et al. Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model. Journal of Endourology. 2003 Jun 1;17(5):307-312.
Baldwin, D. Duane ; Herrell, S. Duke ; Dunbar, Jennifer A. ; Jung, C. ; Nunnally, Amy H. ; Roberts, Richard L. ; Leach, Jeffrey R. ; Parekh, Dipen J ; McDougall, Elspeth M. / Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model. In: Journal of Endourology. 2003 ; Vol. 17, No. 5. pp. 307-312.
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abstract = "Background and Purpose: Laparoscopic radical cystectomy with orthotopic ileal neobladder creation is a technically challenging and lengthy surgical procedure. We present our experience with a simplified technique for laparoscopic cystectomy and neobladder creation in the porcine model. Materials and Methods: Ten female minipigs underwent a purely laparoscopic radical cystectomy with orthotopic ileal neobladder creation. Nine ureterointestinal anastomoses were performed using a simplified {"}dunk{"} technique, where the ureter was prolapsed 5 mm into the afferent limb and the periureteral tissue was secured to the bowel serosa with three superficial sutures. Six ureters were not stented, and three had indwelling stents inserted. In 11 ureters, the anastomosis was performed using a running mucosa-to-mucosa technique (three with stents, eight without stents). The Lapra-Ty suture clip (Ethicon Endosurgery, Cincinnati, OH) was used to secure the running sutures on the urethra, ureters, and neobladder. Animals were harvested at 3 to 8 weeks (mean 6.5 weeks) after surgery. Serology, static cystogram, intravenous urography, and gross and histopathologic evaluations were performed. Results: Of six unstented dunked ureterointestinal anastomoses, two (33{\%}) were widely patent, two were strictured but patent, and two were completely obstructed. In the three stented ureters implanted using the dunk technique, one (33{\%}) was widely patent, one was strictured, and one was completely obstructed. All ureterointestinal anastomoses performed with a mucosa-to-mucosa running anastomosis, whether stented (three ureters) or not stented (eight ureters), were widely patent. Lapra-Ty clip migration into the neobladder pouch caused urethral obstruction resulting in delayed bladder perforation in two animals. Conclusions: Laparoscopic cystectomy and ileal neobladder creation is technically feasible. Attempts to simplify the ureterointestinal anastomosis require further evaluation and modification. Stent placement appears to be unnecessary in the laparoscopic ureterointestinal anastomosis. Laparoscopic creation of the ileal neobladder remains a technically challenging procedure.",
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AU - Nunnally, Amy H.

AU - Roberts, Richard L.

AU - Leach, Jeffrey R.

AU - Parekh, Dipen J

AU - McDougall, Elspeth M.

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N2 - Background and Purpose: Laparoscopic radical cystectomy with orthotopic ileal neobladder creation is a technically challenging and lengthy surgical procedure. We present our experience with a simplified technique for laparoscopic cystectomy and neobladder creation in the porcine model. Materials and Methods: Ten female minipigs underwent a purely laparoscopic radical cystectomy with orthotopic ileal neobladder creation. Nine ureterointestinal anastomoses were performed using a simplified "dunk" technique, where the ureter was prolapsed 5 mm into the afferent limb and the periureteral tissue was secured to the bowel serosa with three superficial sutures. Six ureters were not stented, and three had indwelling stents inserted. In 11 ureters, the anastomosis was performed using a running mucosa-to-mucosa technique (three with stents, eight without stents). The Lapra-Ty suture clip (Ethicon Endosurgery, Cincinnati, OH) was used to secure the running sutures on the urethra, ureters, and neobladder. Animals were harvested at 3 to 8 weeks (mean 6.5 weeks) after surgery. Serology, static cystogram, intravenous urography, and gross and histopathologic evaluations were performed. Results: Of six unstented dunked ureterointestinal anastomoses, two (33%) were widely patent, two were strictured but patent, and two were completely obstructed. In the three stented ureters implanted using the dunk technique, one (33%) was widely patent, one was strictured, and one was completely obstructed. All ureterointestinal anastomoses performed with a mucosa-to-mucosa running anastomosis, whether stented (three ureters) or not stented (eight ureters), were widely patent. Lapra-Ty clip migration into the neobladder pouch caused urethral obstruction resulting in delayed bladder perforation in two animals. Conclusions: Laparoscopic cystectomy and ileal neobladder creation is technically feasible. Attempts to simplify the ureterointestinal anastomosis require further evaluation and modification. Stent placement appears to be unnecessary in the laparoscopic ureterointestinal anastomosis. Laparoscopic creation of the ileal neobladder remains a technically challenging procedure.

AB - Background and Purpose: Laparoscopic radical cystectomy with orthotopic ileal neobladder creation is a technically challenging and lengthy surgical procedure. We present our experience with a simplified technique for laparoscopic cystectomy and neobladder creation in the porcine model. Materials and Methods: Ten female minipigs underwent a purely laparoscopic radical cystectomy with orthotopic ileal neobladder creation. Nine ureterointestinal anastomoses were performed using a simplified "dunk" technique, where the ureter was prolapsed 5 mm into the afferent limb and the periureteral tissue was secured to the bowel serosa with three superficial sutures. Six ureters were not stented, and three had indwelling stents inserted. In 11 ureters, the anastomosis was performed using a running mucosa-to-mucosa technique (three with stents, eight without stents). The Lapra-Ty suture clip (Ethicon Endosurgery, Cincinnati, OH) was used to secure the running sutures on the urethra, ureters, and neobladder. Animals were harvested at 3 to 8 weeks (mean 6.5 weeks) after surgery. Serology, static cystogram, intravenous urography, and gross and histopathologic evaluations were performed. Results: Of six unstented dunked ureterointestinal anastomoses, two (33%) were widely patent, two were strictured but patent, and two were completely obstructed. In the three stented ureters implanted using the dunk technique, one (33%) was widely patent, one was strictured, and one was completely obstructed. All ureterointestinal anastomoses performed with a mucosa-to-mucosa running anastomosis, whether stented (three ureters) or not stented (eight ureters), were widely patent. Lapra-Ty clip migration into the neobladder pouch caused urethral obstruction resulting in delayed bladder perforation in two animals. Conclusions: Laparoscopic cystectomy and ileal neobladder creation is technically feasible. Attempts to simplify the ureterointestinal anastomosis require further evaluation and modification. Stent placement appears to be unnecessary in the laparoscopic ureterointestinal anastomosis. Laparoscopic creation of the ileal neobladder remains a technically challenging procedure.

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