Totally Intracorporeal Laparoscopic Radical Cystectomy with Detubularized Sigmoid Orthotopic Neobladder: Technique Description and Preliminary Outcomes

OBJECTIVE: To describe our technique for totally intracorporeal laparoscopic radical cystectomy with detubularized sigmoid orthotopic neobladder (SONB) and to report its preliminary outcomes. MATERIALS AND METHODS: Between April 2023 and May 2025, eight male patients with pathologically confirmed muscle-invasive or bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer underwent nerve-sparing laparoscopic radical cystectomy, standard pelvic lymph node dissection, and totally intracorporeal laparoscopic SONB construction performed by a single surgeon. Demographic, perioperative, pathological, and functional data were collected retrospectively; preliminary outcomes are reported. RESULTS: All procedures were completed successfully without conversion to open surgery. Median operative time was 502.5 minutes (interquartile range [IQR]: 424.5-636.3), and median estimated blood loss was 100 mL (IQR: 62-275). Surgical margins were negative in all patients. Daytime urinary continence was good in six patients and satisfactory in one; one patient had unsatisfactory daytime continence. Nighttime continence was good in four patients, satisfactory in three, and unsatisfactory in one. Erectile function recovered in four patients. Low-grade complications (Clavien-Dindo grade I-II) occurred in four patients; one patient experienced a high-grade complication (grade IIIb) consisting of a sigmoid neobladder-rectal fistula. CONCLUSIONS: Totally intracorporeal laparoscopic radical cystectomy with detubularized SONB construction seems feasible in select patients, yet the observed event warrants caution. This approach may serve as a valuable alternative for select patients undergoing laparoscopic radical cystectomy. Longer follow-up is required to confirm oncological and functional durability.