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Tak et al. Mini-invasive Surg 2018;2:15 I http://dx.doi.org/10.20517/2574-1225.2018.05 Page 5 of 8

Table 4. Level of significance of complications among the two groups
Complications Ileus ≤ Ileus > Wound No wound Anastomotic No anastomotic All No Death No
3 days 3 days infection infection leak leak complications complications death
Group A 42 11 8 45 1 3 13 40 2 51
Group B 12 51 22 41 3 60 30 33 3 60
P value 0.001 0.008 0.17 0.006 0.47

Table 5. Urinary diversion distribution of study population
Ileal conduit Neobladder Total
Group A 44 9 53
Group B 44 19 63

In our retrospective study, postoperative pain score (calculated by visual analogue score) (P = 0.0001),
analgesic requirement (P = 0.0003), length of hospital stay (P = 0.0004), duration of surgery (P = 0.0006),
postoperative paralytic ileus duration (P = 0.0006), postoperative wound complication (P = 0.008) were less
(statistically significant P < 0.05) for group A as compared to group B. But the postoperative hemoglobin
drop (P = 0.08), the number of units blood transfused (P = 0.189), and lymph node yield (P = 0.533) were
not significantly different statistically (comparable) among the two groups. No statistically significant
difference with respect to age and gender in either group was found (P = 0.30, P = 0.57 respectively). For
experienced minimal access surgeons, the ablative part of this procedure does not cause major problems
but the urinary diversion part of the surgical procedure is challenging and requires more advanced
laparoscopic skills .
[2]

DISCUSSION
Open radical cystectomy (RC) with urinary diversion (ileal conduit or ileal neobladder) has been the gold
standard for treating muscle-invasive bladder malignancy . Recently, minimal access approach has been
[3]
adopted for radical cystectomy in performing laparoscopic RC and robotic RC. As mentioned previously,
the minimally invasive approach has various advantages like magnified vision, less blood loss, minimal the
postoperative pain, rapid postoperative recovery, less hospital stay and gives better cosmesis .
[3]
Those who have expertise in advanced laparoscopy have adopted three approaches to reconstruction:
1. Extracorporeal reconstruction through a mini-laparotomy midline or muscle-splitting incision or
Pfannenstiel incision. The same incision is used for delivering the bladder specimen and lymph nodes in
laparoscopic sacks. We used this approach in our study;
2. A combination of extracorporeal construction of a urinary reservoir and intra-corporeal anastomosis;
3. Complete intra-corporeal reconstruction .
[2]
A completely intra-corporeal procedure is a technically difficult and time-consuming procedure .
[4]
Manoharan et al. described the Pfannenstiel incision for it.
[4]
As for the patients included in group A, out of 53 patients only 4 (7.5%) underwent ileal neobladder, while
in group B out of 63 patients 9 underwent ileal neobladder (16.6%). All the remnant patients in either group
underwent ileal conduit urinary diversion [Table 5].

Table 6 demonstrates the final histopathological T and N stage distribution of the patients under study.

In contrast to vertical incision, with Pfannenstiel incision, the whole pelvis was easily accessible, without
a retractor being applied to the lateral edges . Postoperative paralytic ileus duration was significantly
[3]
higher in patients having lower midline incision, though we adopted the intra-peritoneal approach. The