European Urology European Urology 44 (2003) 567–572 LaparoscopicNerve-andSeminal-SparingCystectomy withOrthotopicIlealNeobladder:TheFirstThreeCases Giorgio Guazzoni * , Andrea Cestari, Renzo Colombo, Massimo Lazzeri, Francesco Montorsi, Luciano Nava, Andrea Losa, Patrizio Rigatti Department of Urology, Universita ` Vita e Salute, San Raffaele-Ville Turro, Via Stamira D’Ancona 20, 20127 Milan, Italy First published online 9 August 2003 Abstract Introduction and Objectives: Seminal and prostate sparing cystectomy represents an alternative in young patients where preservation of urinary continence and sexual potency are fundamental. We present our preliminary experience with this procedure performed laparoscopically. Methods: Three men—53, 58 and 49 years old—suffering from recurrent superficial transitional cell carcinoma of the bladder, resistant to intravesical therapy, underwent laparoscopic nerve, prostate and seminal vesical sparing cystectomy. One week before surgery, TURP was performed to create an adequate prostate capsule. After pneumoperitoneum induction and the positioning of five/six trocars, the ureters were clipped and transected, the vas deferens and seminal vescicles were identified and prepared for the conservative procedure. Cystectomy was performed with vascular pedicles transection by EndoGia. The reconstruction of the bladder was obtained through a 7 cm longitudinal periumbilical incision using 60 cm of ileus and an orthotopic neobladder realized outside the abdomen. The ileocapsular anastomosis was performed laparoscopically after the re-induction of pneumoperito- neum. Results: No major complications were recorded. The surgical time was respectively 480, 450 and 410 min. Blood loss was 150, 220 and 300 ml respectively. Drains were removed after 4 days (two patients) and 6 days (one patient) and the patients were discharged after 8 days (two patients) and 9 days. The patients were fully continent after catheter removal with normal uroflowmetry. At the three month follow-up they had a normal sexual function, equivalent to the preoperative assessment. The patients reported adequate erections for intercourse. Conclusions: Laparoscopic prostate and seminal cystectomy with orthotopic ileal neobladder is a safe, feasible, reproducible surgical technique. In patients who desire to preserve sexual functioning and obtain complete continence it represents a valid alternative to classic radical cystectomy. # 2003 Elsevier B.V. All rights reserved. Keywords: Laparoscopy; Bladder cancer; Cystectomy; Potency; Urinary continence 1. Introduction Laparoscopic surgery is becoming progressively more popular within the urological community. Together with surgeons’ increased confidence and skill, recent technical developments have allowed many cen- ters to perform major laparoscopic procedures routinely, while new laparoscopic approaches are being tested for feasibility, cost-benefit analyses and clinical results in comparison to open surgery [1–3]. At present, only a few experiences dealing with laparoscopic radical cystectomies in the treatment of transitional cell carcinoma of the bladder have been reported in the literature. In addition, to-date the lack of an adequate, long-term oncological follow-up suggests approaching a bladder tumour via laparoscopy with caution and only in selected patients [4–8]. However, preliminary experiences show that a radical cystectomy * Corresponding author. Tel. þ39-02-26433357; Fax: þ39-02-26433357. E-mail address: guazzoni.giorgio@hsr.it (G. Guazzoni). 0302-2838/$ – see front matter # 2003 Elsevier B.V. All rights reserved. doi:10.1016/S0302-2838(03)00363-4