Objective:To investigate the feasibility and safety of extraperitoneal laparoscopic radical cystectomy (ELRC) with intracorporeal ileal conduit urinary diversion (Bricker surgery). Methods:From Mar. 2020 to Dec. 2023,a total of 42 male patients,aged between 60 and 84 years old,who underwent ELRC and were diagnosed with muscle invasive bladder cancer,were included in the study as observation group. The average age was (69. 2±4. 9) years. The median incision was approximately extended to 5 cm in order to extract the specimen. Bricker surgery was performed after specimen extraction,the loop of the ileum was completely isolated from the abdominal cavity. In addition,38 patients who underwent transabdominal laparoscopic radical cystectomy and Bricker surgery by the same surgeon team from Mar. 2020 to Dec. 2023 were considered as the control group. And the two groups were compared in terms of operation time,blood loss,number of lymph nodes dissection,postoperative intestinal function recovery time,intestinal obstruction and incision healing. Results:All 42 patients in the observation group were successfully operated,and no cases were converted to laparotomy. In observation group and control group,there were no significant differences in operative time of laparoscopic stage[(172. 3±25. 5)min vs. (172. 1±27. 4)min],blood loss[(194. 5±100. 5)mL vs. (207. 6±107. 8)mL],number of lymph node harvested[(11. 6±2. 9) vs. (11. 8±2. 7)],there were statistically significant differences in postoperative intestinal function recovery time[(2. 2±0. 4)d vs. (3. 4±0. 6)d,P＜0. 05],incidence of postoperative intestinal obstruction (0 vs. 7,P＜0. 01)and incision undesirable healing(1 vs. 9,P＜0. 01). Conclusions:ELRC with Bricker operation is safe and reliable,and takes advantage of the extraperitoneal location of the bladder and the natural barrier provided by the peritoneum,this improved surgical approach completely positions the ileal loop and ureteral anastomosis outside the peritoneum,resulting in a significant reduction in intestinal obstruction and incisional infection rate,and quick recovery of postoperative intestinal function. This procedure is worthy of clinical promotion and application.
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