Our initial experience with the three layers with three-port approach for laparoscopic radical cystectomy

Introduction
Radical cystectomy (RC) remains the gold standard for the treatment of recurrent high-risk non-muscle-infiltrating bladder cancer (BC) and muscle-infiltrating BC. Currently, there is no uniform standardized procedure for laparoscopic radical cystectomy (LRC) . Aim: To share our initial experience with the three layers with three-port approach for laparoscopic radical cystectomy (TLTPA-LRC) and to investigate its safety and effectiveness.

Material and methods
Between April 2017 and March 2020, 32 patients with bladder tumors underwent TLTPA-LRC, pelvic lymph node dissection, and extracorporeal construction of the Studer neobladder. The basic characteristics of the patients, clinical pathology, and perioperative and follow-up data were analyzed. We also describe our step-by-step surgical technique for TLTPA-LRC.

Results
The median operation time was 278.5 min (range: 221–346 min), and the mean estimated blood loss was 233.4 ml (102–445 ml). The rates of intraoperative blood transfusion and postoperative transportation to the intensive care unit after surgery were 12.5% and 100%, respectively. Postoperative pathology showed seven cases of T1, 20 cases of T2, and 5 cases of T3. Lymph node dissection and surgical margins were both negative. During a median follow-up of 13.5 months, four patients had early complications (< 30 days) and no patients had major complications (grade ≥ 3). The patients are now alive without local metastasis and with satisfactory urinary control ability day and night.

Conclusions
Although the TLTPA-LRC approach requires a certain level of surgical proficiency, it is feasible and serves as a minimally invasive method for selected patients.