There are great differences in the treatment methods, treatment goals, survival rate and recurrence rate of BC. In non muscle invasive BC, the goal is to prevent progression and limit recurrence. About 75% of bladder cancers are non-invasive and usually have a good prognosis. In muscle invasive BC, our goal is to decide whether to retain or resect the bladder. About 25% of bladder cancer is muscle invasive. With the development of laparoscopic technique, LRC has replaced the traditional open radical cystectomy.In addition, LRC has the advantages of less bleeding and rapid recovery.Therefore, the patients with bladder tumor need radical cystectomy, that laparoscopic surgery is the first choice.There are many ways to establish the operation hole of laparoscopic surgery.Single incision laparoscopic surgery needs to overcome the difficulty of instrument collision and lack of triangular traction, and the learning curve of this technique is relatively long.Traditional laparoscopic radical cystectomy, usually choose 5 operation holes.However,with the development of three port laparoscopy, its short-term and pathological results are the same as or even better than five port laparoscopy. Reducing the number of laparoscopic holes is a challenging technique.This study collected the data of our hospital using 3 hole LRC for brief analysis.
Under the background of rapid economic growth, there are obvious differences in the allocation of health resources and the utilization and distribution of health services in China. Therefore, reasonable conservation of health resources, so that it is more needed in the area is a very meaningful thing.The cost of trocar can be reduced by using 3-hole radical cystectomy. Reduce the cost of surgery, more reasonable allocation of medical resources.Due to the reduction of puncture holes and body surface trauma, psychological suggestion, it can be given to patients to accelerate their recovery.
It can be seen from the statistical results that 3 hole radical cystectomy can effectively save the operation time.The operation time was closely related to postoperative intestinal function recovery, surgical site infections and postoperative mortality.In the study of SM et al., it has been shown that prolonged abdominal surgery is a risk factor for increased intraoperative mortality.The incidence of surgical site infection (SSI) varies from 0.1–50% according to the procedure, specialty and condition. The duration of surgery is often considered to be an independent and potentially modifiable risk factor for SSI.The reduction of operation time can reduce the anesthesia time, which is conducive to postoperative intestinal recovery.Therefore, we recommend the three hole LRC.
Orthotopic neobladder is a common urinary diversion after RC for bladder cancer. It is also one of the most challenging operations for urologists. The advantages of neobladder include better quality of life and avoidance of psychological complications caused by ostomy.In the comparison of urinary diversion to orthotopic neobladder, the results showed that there was no significant difference in operation time between the two groups(294.5 ± 52.98 vs 303.47 ± 45.48), but the exhaust time and postoperative hospital stay were significantly reduced, the difference was statistically significant (3-hole vs 5-hole).The reason that there was no significant difference in operation time between the two groups may be that 75% of the patients in the three holes underwent total laparoscopic orthotopic neobladder, which prolonged the operation time.In the comparison of in vivo and in vitro in orthotopic neobladder, the postoperative ventilation time was significantly shorter in vivo, and the difference was statistically significant.The absence of intestinal exposure accelerated the postoperative ventilation time and prolonged the postoperative hospital stay.Early ventilation and early eating can stimulate faster peristalsis of gastrointestinal tract and promote faster recovery of physical strength and energy of patients.Shortening the length of hospital stay is beneficial to reducing the incidence of hospital infection, speeding up the turnover of hospital beds and reducing the consumption of medical resources. Therefore, we recommend the 3-hole tatal laparoscopic radical cystectomy and orthotopic neobladder.
Overlap anastomosis was first used for anastomosis at the end of gastrectomy. It is a linearstapled reconstruction technique using an isoperistaltic side-to-side method.This way of anastomosis is more in line with intestinal peristalsis and can restore the intestinal function earlier.Therefore, we recommend the overlap type anastomosis for end-to-end intestinal anastomosis.
The peritoneum is composed of mesothelial cells and basement membrane, and shows epithelial characteristics, which can effectively prevent adhesion between intestinal tract and platoon, and reduce the mechanical friction between them.Pelvic peritoneal reconstruction is a separation technique that can separate the abdominal cavity from the pelvic cavity, thus preventing the small intestine from entering the pelvic dead space. Studies have shown that it can reduce the incidence of pelvic effusion and intestinal obstruction.So,we recommend continuous suture to reconstruct the external peritoneum and restore its integrity and continuity.
Extraperitoneal radical cystectomy can reduce the inflammatory reaction between the intestine and pelvic wall, and reduce the incidence of small bowel paralysis, obstruction, intestinal obstruction or constipation.Therefore, extraperitoneal resection can be performed for early bladder cancer.
In conclusion, in order to reduce the intestinal complications, we can use overlap anastomosis, reconstruction of the lateral peritoneum and extraperitoneal resection.Of course, in the process of three hole LRC, the use of these techniques can make the patients get the maximum benefit.
There are some limitations in this study.First, because this study is a retrospective study, there may be some selection bias.In order to avoid selection bias, strict inclusion criteria were established.Secondly, due to the lack of data analysis of operation skills, credibility may be insufficient. In order to avoid this shortcoming, we will make a comparative analysis of operation skills of each group in the future study.Finally, due to the short time of 3-hole LRC project, there is no long-term follow-up study with large samples.In future study, we will conduct multi-center long-term follow-up study.