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Laparoscopic urologic surgery in malignancies - part 5

Trong trường hợp thay thế bàng quang orthotopic, những lợi thế của hai mạch máu tiếp hợp với nhau vesicourethral nội soi ổ bụng để được xem xét trong điều khoản của watertightness ngay lập tức để tăng dục sớm và tránh bất kỳ stenoses tiếp theo. Các tùy chọn khác nhau có sẵn để dẫn dòng nước tiểu được tóm tắt trong | 5.2 Laparoscopic Radical Cystectomy with Orthotopic Bladder Replacement 111 Table 5. Laparoscopic urinary diversion - technical steps and options Operative Step Options Comments Transposition of ureter None Not for sigmoid-neobladder or neopouch Creation of reservoir Ileal pouch Intracorporeally Extracorporeally laparoscopically assisted Sigmoid neobladder Sigmoid pouch Ileal conduit in females Ileal conduit in males Ileal neobladder Ureteral anastomosis Intracorporeally Extracorporeally Sigmoid neobladder Sigmoid pouch Ileal conduit Ileal neobladder Ileal pouch Urethral anastomosis Intracorporeally All continent diversions In cases of orthotopic bladder replacement the advantages of the laparoscopic vesicourethral anastomosis are to be considered in terms of immediate watertightness to increase early continence and avoid any subsequent stenoses. The various options available for urinary diversion are summarized in Table 5. Involvement of Robotics in the Field of Laparoscopic Radical Cystectomy Two groups recently reported their early experience with the use of Da Vinci telemanipulators in the field of laparoscopic radical cystectomy 48 followed by in-tracorporeal creation of an ileal bladder 49 . The role of the robotic i ms was essentially limited to the nerve-sparing dissection during the ablative time and to the vesicourethral anastomosis in cases of neobladders. This adds to the catalogue of urologic procedures already described with robotic assistance 50 51 . Further functional results are still awaited to evaluate the true return of this investment in the fields of reduced operative times improved erectile function and optimal neobladder. Perspectives of Laparoscopic Radical Cystectomy Radical cystectomy remains the gold standard for muscle-invasive bladder cancer and high-risk superficial tumors resistant to intravesical therapy and a laparoscopic approach can reproduce open surgery. Op erative times for these radical procedures however remain longer than .