Histologic And Experimental Background

In 1992, Parra et al. (5) documented the initial case report of laparoscopic simple cystec-tomy in female patient suffering from recurrent pyocystis of retained bladder in a 27-year-old paraplegic woman who had already undergone open surgical urinary diversion a few months earlier. The operative time was 130 minutes. The authors described postoperative hospital stay of five days, which was significantly less than that in five similar patients undergoing open cystectomy for vesical empyema in whom the mean hospital stay was 20.6 days. In 1992, Kozminski and Partamian (6) described the first case report of laparoscopically assisted ileal conduit construction, with the bowel anastomosis and both Bricker ureteroileal anastomosis performed extracorporeally through extended port sites. In 1995, Sanchez de Badajoz et al. (7) described the first case of laparoscopic-assisted radical cystectomy with an ileal conduit performed extracorporeally in a 64-year-old woman who had invasive bladder carcinoma. The authors discussed that recuperation was unusually fast and painless, and little postoperative analgesia was required. In 1999, Denewer et al. (8) conducted a series of 10 patients undergoing laparoscopic-assisted cys-tectomy with open surgical sigmoid pouch, including two patients subjected to primary treatment for bladder tumor, but seven patients to salvage options as well as one to a palliative option after unsuccessful courses of radiotherapy for bladder malignancy.

Although the above reports established laparoscopic feasibility of certain portions of laparoscopic cystectomy or urinary diversion, it was not until 2000 that entire laparo-scopic radical cystectomy and completely intracorporeal ileal conduit urinary diversion was employed clinically in two male patients with bladder cancer (1), following a successful pilot study in 10 pigs by Cleveland Clinic (9). Similarly, in author's institution, the completely intracorporeal orthotopic ileal neobladder was initially developed successfully in animal study using 12 pigs (10), followed by clinical application of orthotopic urinary diversion in one man and in one woman, and an Indiana pouch in one man (2).

In 2000, Turk et al. described laproscopic radial prostatectomy with Mainz II pouch entirely intracorporeally also in three men and two women with bladder cancer (11). These reports demonstrated that reconstruction of bowel could be performed with purely intracorporeal freehand suturing techniques.

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