Laparoscopic radical cystectomy and bricker operation with modified four-hole method (report of 31 cases)

Yang Guoqiang; Chen Guangfu; Zhang Xu; Sun Shengkun; Zhu Jie; Zhang Peng; Wang Yunpeng

doi:10.3969/j.issn.2095-5146.2015.04.002

Abstract：Objective:To evaluate the clinical efficacy and application value of modified four-hole laparoscopic radical cystectomy and bricker operation.Methods:Between January 2014 and June 201 5,31 patients (26 males and 5 females)underwent modified four-hole laparoscopic radical cystectomy and bricker operation by the same surgeon. The mean age was 63.7 years (47-78 years).Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed (uterus,bilateral ovaries and part of anterior vagina wall in females)with traditional four-hole method.The specimen and marked intestine were taken out from the expanded working canal on the right exterior of rectus abdominis (vagina in females).The ileal conduit was then completed.Results:All operations were performed successfully.There was no conversion to open surgery.The mean surgical duration was 307.7 min (240-420 min). The mean estimated blood loss was 243.5 mL (100-500 mL).Two cases were given transfusion of 650 and 680 mL during operation,due to slight anemia,respectively.All surgical margins were negative.All patients engaged in ac-tivities 2-4 days postoperatively.The anal exhaust time was 4-7 days postoperatively.There was no urinary,intesti-nal fistula and other severe complications.Two patients who suffered incomplete intestinal obstruction were cured af-ter conservative treatment.One patient who suffered slight bilateral hydronephrosis due to urinary infection after re-moval of the single J stent recovered after the conservative treatment.Conclusions:The modified four-hole laparo-scopic radical cystectomy and bricker operation is a better improvement based on the traditional four-hole method.It is worth applying and recommending with shorter incision,more cosmetic and quicker recovery.