Common Complications and Management of Urinary NOSES

Abstract

Radical cystectomy with urinary diversion is one of the most complicated and important operations in urology. The operation time is long, the operation risk is high, and the complication rate is high. NOSES is technically feasible and safe. Compared with conventional laparoscopic surgery, the most important and intuitive advantage of NOSES is that it avoids the auxiliary incision of extracting samples from the abdominal wall, and there are only a few tiny card scars left in the abdominal wall after operation. It reduces the estimated blood loss and postoperative complications. It is noteworthy to surgeons that serum albumin significantly reduced after LRC, nutrition should be kept balanced after surgery, and the most common complication was hypoproteinemia. NOSES is more minimally invasive and cosmetic without increasing surgical complications and affecting the pelvic floor function. There were no difference between NOSES and conventional laparoscopic surgery in pelvic floor dysfunction. We analyzed that transvaginal specimens extraction needed to cut open the posterior vaginal fornix, but the blood flow of the posterior vaginal wall was good, no tension after continuous suturing, and the vaginal wall had strong extensibility and repair ability, and the patient’s postoperative incision healed well. It was recommended that the specimen was removed through the vagina to reduce postoperation complications. To sum up, transvaginal specimen extraction in laparoscopic surgery for bladder cancer is safe and feasible.