Radical Cystectomy

Radical cystectomy proceeds as described elsewhere. Several specific points deserve attention:

1. Laparoscopic access: Pneumoperitoneum is obtained through a standard Veress technique. A primary 10-mm trocar is placed at the umbilicus. An additional four trocars are placed in a fan-shaped distribution. Two 10-mm trocars are placed at the lateral pararectal line 10 cm above the pubic symphysis, and two 5-mm trocars 2-3 cm medial and superior to the anterior-superior iliac spines.

2. Ureteral dissection: Ureters are clipped and transected close to their insertion into the bladder. This greatly facilitates subsequent identification and atraumatic laparo-scopic manipulation.

3. Two different colored 4-0 Vicryl holding sutures are placed at the distal ends of the ureters.

4. Vascular pedicle control: The vascular pedicles of the bladder and prostate are controlled with serial applications of an Endo-GIA laparoscopic stapler.

5. Specimen retrieval: Once the bladder is fully excised, it is placed into a laparoscopic retrieval bag. Once the abdomen is incised for creation of neobladder, the specimen can then be removed.

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