ABSTRACT
In the female, anterior pelvic exenteration with en bloc removal of the bladder, uterus, fallopian tubes, ovaries, and anterior vaginal wall represented the standard technique for many years. The authors propose a step-by-step description of the technique of laparoscopic radical cystectomy in the female. The available literature supports the performance of an orthotopic urinary diversion in appropriately selected women following radical cystectomy for primary bladder malignancy. From an oncologic point of view, preoperative absence of tumor in the bladder neck and vagina and a negative full-thickness intraoperative frozen section analysis of the proximal urethra indicate the preservation of the urethra with neobladder reconstruction. The detailed topographic anatomy of the pelvic autonomic nerves innervating the vagina, urethra, and bladder allows the surgeon to perform a nerve-sparing radical cystectomy with preservation of the vagina and in some selected cases of the uterus, in order to preserve sexual function in females.
