[Comment to "Laparoscopic radical cystectomy with extracorporeal creation of a 'Y' shaped orthotopic ileal neobladder using non-reabsorbable mechanical suture (Fontana)"].

Laparoscopic radical cystectomy is a complex surgical procedure that even in experienced groups involves a lengthy operative time. Consensus is general regarding the creation of an intestinal neobladder and performance of ureterointestinal anastomosis by means of a minilaparotomy. This would reduce operative time without compromising the advantages of the laparoscopic approach. In this article, the authors describe that the use of a ‘‘Y’’ shaped neobladder with nonabsorbable mechanical suture, according to the technique described by Fontana et al.,1 signifies a substantial reduction in the surgical time required to create the neobladder in comparison with other techniques. The use of non-detubularized ileal segments to anastomose the ureters to them allows for less movement of the ureter and the use of more proximal and better vascularized ureteral segments for the uretero-intestinal anastomosis. Although Hautmann et al. had already proposed this in the modification of their original technique,2