Bordeaux technique for intracorporeal Orthotopic ileal neobladder.:illustration of surgical tricks and evaluation of perioperative outcomes in a referred center
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in selected patients with muscle-invasive bladder cancer following radical cystectomy (RC). Various techniques are currently used and have shown satisfactory outcomes. The present video is intended to illustrate key surgical steps, tricks and preoperative outcomes of our standardized technique of ONB.
In our center 97 RARC were from 2016 to 2021. Of these, 33 pts who selected for NB reconstruction. All the procedures were performed by the same surgeon. All the pts were subjected for an enhanced recovery after surgery (ERAS) protocol.
The tecquinique used was intracorporeal Y-modified neobladder (“Bordeaux Neobladder”).
It consists in a reconstruction with an ideal segment of 40 centimeters, isolated approximately 25 centimeters from the ileocecal valve. At medium this segment is open and a double semicircular uretral-ileal anastomosis is obtained. Both ends of the selected ileal segment are then divided with the aid of a laparoscopic 60 millimeters intestinal stapler.
Ileal continuity is restablished through an aniso-peristaltic anastomosis.
The middle anti mesenteric part of the selected ileal segment is opened with scissors in order to obtain its detubularization. The medial margins are sutured and the posterior plate is created. The anterior bladder neck is then remodelled and the wire used for the posterior reconstruction is used to connect the end of the posterior reconstruction to the anterior bladder neck. Two lateral sutures are performed to close the neobladder until almost 5 centimeters before to complete the closure of the lateral wall. The ureters are spatulated and then reimplanted following a Wallace technique at the open ends of neobladder limbs. Once the posterior reconstruction of the anastomosis is completed, a single j stent is percutaneously inserted on a guidewire and then the anastomosis is completed.