Anatomy,Histological Basis And Surgical Technique Of The Bladder Lateral Ligament

BackgroundBladder cancer is the most common malignant tumor of the urinary system,which is a direct threat to life.The incidence of this disease in China has an increasing trend.Radical cystectomy is the gold standard for the treatment of bladder cancer.The surgical treatment is to remove the whole structure of the bladder and surrounding structures,and the treatment is gradually developed from the traditional radical cystectomy to laparoscopic radical cystectomy and robot-assisted laparoscopic radical cystectomy.The diversity of treatment methods is beneficial for different patients.Traditional radical cystectomy is more common in primary hospitals because of its relatively low cost and long-term promotion time;robot-assisted laparoscopic radical cystectomy has been carried out in some large medical centers in China,its application is difficult between domestic hospitals and it is difficult to achieve economic benefits;in comparison,laparoscopic radical cystectomy is currently used in China.There is a certain foundation,which can achieve more fine and minimally invasive effects in surgical treatment.Combined with chinese national conditions,laparoscopic radical cystectomy is a relatively economical and practical technology,which is worthy of further popularization.How to maintain complete resection of the tumor while reducing the damage to the surrounding structure during the operation,which requires a very detailed understanding of the anatomy of the anatomical structure around the bladder,and carry out refined processing on it.Therefore,this paper mainly focuses on the treatment of the bladder lateral ligament and its anatomical and histological characteristics in radical cystectomy.ObjectiveTo further understanding the anatomical and histological of the bladder ligament and summarizing the surgical points in radical cystectomy.MethodsReview the literature on the bladder ligament,analyze and summarize its anatomical and histological features.Through watching the complete video of laparoscopy in radical bladder cancer resection completed by my tutor,13 cases were recorded.And other professors explained the video recording in 7 cases.The main points of the treatment of bladder ligament in laparoscopic radical surgery for bladder cancer were summarized.Results20 cases of surgery video in the whole group,accurate separation and exposure of the bladder lateral ligament were performed,and the lateral and medial boundaries of the lateral vesical ligament were completely exposed.For the ligation of the bladder ligament,16 cases of Hem-O-lok with laparoscopic scissors,2 cases of Ligasure,2 cases of Hem-O-lok with ultrasonic scalpel,although the ligation method is different,the structure was effectively ligated.ConclusionIn laparoscopic radical cystectomy,the treatment of the bladder ligament is mainly through the lymphatic and adipose tissue to reveal the lateral interface.Subsequently exposed the seminal vesicle and prostate,open the Denonvilliers'fascia.Then,the posterior side of the bladder can be completely dissociated along the upper part of the fascia.Finally,the bladder side ligament was ligated with Hem-O-lok and scissors.This method is currently a practical technique for treating the bladder side ligament.