Clinical Experience And Application Of Level Anatomy During In The Laparoscopic Radical Cystectomy

0bjective:To evaluate the value of anatomy levels during the radical laparoscopic cysectomy for muscle invasive bladder cancers.Methods:Retrospective Analysis: The clnical data of 39 patients who underwent laparoscopic radical cystectomy fro m August 2010 to June 2014. According to the order of sides, there are the posterior and anterior during LRC.Lateral levels established: First free bilateral ureters, bilateral pelvic lymph node dissection, and reservation obturator vessels. Then separate the inside of the obturator vessels the bladder side of the gap, locate the proximal common iliac artery bifurcation, then remote direct pelvic fascia, and appropriate cut pelvic fascia. Thus the facing layer is fully established. Afterward the posterior level is established: cut from the lowest point of the rectal bladder fossa 2 cm open basin peritoneum, free the seminal vesicles and vas deferens. Seminal vesicle ligament transection is done and the seminal vesicle is lifted, exposing the dieldrin fascia which is resected. Thenthe adipose tissue is observed, allowing to locate the Disse space around the two separate prostate, directly behind the apex of the prostate. Thus after plane is established; the levels posterior to the bladder are established: C ut the median umbilical ligament, the n the lateral umbilical ligament is revealed bladder before the plane. Cut the retropubic prostatectomy ligament, fully open the sides of pelvic fascia to the back after deep vein complex is fully exposed, suture deep dorsal penile vein complex body. Cut to free the proximal urethra, then the bladder and the prostate are completely removed.Results:Of the 39 cases patients : male 31 cases,female 9 cases.The age distribution of the patients ranged from 49 to 81 years, an average of(65.8 ± 10.0) years. All the tumors are muscle invasive,and the tumor location of 16 cases in the mut iple areas of the bladder,5 cases in the right side wall,7 cases in the left wall, the bottom 6 cases, the top 2 cases. Tumor size 1.0-7.0cm, average(3.0 ± 1.4) cm. Preoperative clinical staging of 11 cases of T1, 18 cases of T2,8 cases of T3, and 2 cases of T4. Preoperativebiopsy prompted 5 cases of low grade urothelial carcinoma,33 cases of high- grade urothelial carcinoma, and 1 case of signet ring cell carcinoma.39 cases were operated successfully completed, all the operative times were between 180-420 min, the mean(240 ± 88) min, and laparoscopic partial 120-240 min. Intraoperative blood loss was 200 ~ 1200 ml, average(320 ± 116) ml, 2 cases of transfusion, blood transfusion are 800 ml. All the surgical margins were negative. The average number oflymph nodes per patient 4.6, node-positive rate of 3. O%(7/210). Histological biopsy prompted 5 cases of low grade urothelial carcinoma,33 cases of high-grade urothelial carcinoma, 1 case of signet ring cell carcinoma. The patients were followed up for 15.5 ± 8.9months(mean15.5 months),during which time,1 case died of tumor progression,and the other cases were without local or systemic progression.Conclusions: LRC is a safe and effective surgical cystectomy, according to the bladder side level、 post-bladder level and peri-bladder level during the operation.It can maintain a more clear operative field, reduce blood loss and rectal injury risk and shorten the learning curve time,and worthy of promotion in clinical practice.