Laparo-endoscopic single-site radical cystectomy with orthotopic urinary diversion: Technique, feasibility, and the 3-year follow-up (original) (raw)
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Laparoscopic radical cystectomy: initial experience
Actas Urol …, 2007
INTRODUCTION: Radical cystectomy with extended pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. The aim of this study is to report our initial experience of our series of 22 patients who underwent laparoscopic radical cystectomy with different urinary diversion. MATERIALS AND METHODS: Between March 2015 and March 2016, 22 patients have undergone laparoscopic radical cystectomy with different types of extracorporeal urinary diversion. Patients were aged 54 to 85 (average age 66.3) with different clinical stages of the disease. In all of the cases a transperitoneal laparoscopic radical cystectomy with five ports was performed with bilateral extended pelvic lymph node dissection. RESULTS: In 5 cases we performed radical cystectomy with subsequent ureterocutaneostomy, in 7 cases ileal conduit according to the method of Bricker was performed, and in 10 cases we formed an orthotopic bladder from an ileal loop by the method of Hautmann. All operations were performed with an average blood loss of 270 ml, with an average operating time of 5 hours, and an average hospital stay of 7 days. No conversion was required in any of the cases. The patients were observed postoperatively. Early complications (within 30 days) occurred in 2 patients, and late complications occurred in 3 patients. CONCLUSION: Laparoscopic radical cystectomy is possible, although technically difficult, with significant reduction in patient morbidity. With more experience and an improvement of the surgical technique, laparoscopic radical cystectomy with different types of derivation becomes an alternative surgical method for treating patients with localised muscle invasive bladder carcinoma.
Laparoscopic radical cystectomy: operative and pathologic outcomes
Postepy Nauk Medycznych, 2012
Introduction and Objectives. The standard management in invasive bladder cancer patients is radical cystectomy (RC). After cystectomy urinary diversion is often based on conduit or ileal neobladder. Last decade to minimize invasiveness of RC, laparoscopic radical cystectomy was proposed. Wordwide experience in LRC is not high, neverless the nuber of this procedure increases in time. We report our experience with lLRC evaluating efficacy and safety. Material and methods. From February 2006 to June 2008 we performed 22 LCRs in the 22 consecuitive cases of locally advanced bladder cancer (cT2-3N0M0). Results. In 21 patients the procedure was preformed laparoscopically. In one case, because of technical difficulties, conversion to standard, open technique was necessary. The mean time of the surgery was 290 min (270-340 min). The mean blood loss during LCR was 220 mL (from 190 to 550 mL). Blood transfusion was necessary in two cases of LCR. Mean number of removal lymph nodes was 17 (15-25). Three patients (13.5%) had active tumor in the resected lymph nodes. The postoperative course was uncomplicated. Mean hospital stay was 8 days (5-18 days) Conclusions. LCR is technically advanced surgical procedure in the management of invasive bladder cancer. LRC offers complete bladder removal based on oncological criteria in well selected patients and in some of them to create urinary diversion without widespread laparotomy. LRC is less invasive procedure than standard open RC.
International braz j urol : official journal of the Brazilian Society of Urology
We aim to evaluate our experience and results with laparoscopic radical cystectomy and conduct a systematic review of studies reporting on 50 or more procedures. Between February 2006 and March 2011, a prospective study in a single institute on patients with bladder cancer who underwent laparoscopic radical cystectomy was conducted. A search of the Cochrane Library, PubMed, Medline, and Scopus databases was conducted for studies reporting on 50 or more laparoscopic radical cystectomy procedures to compare with our results. Sixty men and five women underwent laparoscopic radical cystectomy during the 5-year study period. Thirty-nine patients were submitted to ileal conduits, 24 to neobladders, and two patients to ureterocutaneostomies. The mean operative time was 294 ± 27 minutes, the mean blood loss was 249.69 ± 95.59 millilitres, the mean length of hospital stay was 9.42 ± 2 days, the mean morphine requirement was 3.69 ± 0.8 days. The overall complication rate was 44.6% (29/65). Ho...
Urology, 2008
Objectives: To report our experience with laparoscopic radical cystectomy and extracorporeal urinary diversion for high-grade muscle invasive bladder cancer in a consecutive series of 48 patients with 3 years of follow-up. Methods: From June 1999 to April 2006, 48 patients (42 men and 6 women; mean age 59 years, range 24 to 80) with bladder cancer underwent laparoscopic radical cystectomy and bilateral pelvic lymph node dissection at our institution. Urinary diversion was done extracorporeally through the specimen extraction incision. Results: The mean operating time was 310 minutes, and the mean blood loss was 456 mL. In 1 patient, conversion to open surgery was required because of severe hypercarbia. Three major complications were observed intraoperatively (rectal injury in 2 and external iliac vein injury in 1 patient). However, all these complications were managed laparoscopically, with completion of the procedure laparoscopically. The mean hospital stay was 10.2 days (range 7 to 25). One patient died in the postoperative period of severe lower respiratory tract infection and septicemia. Histologic examination showed organ-confined tumors (Stage pT1/pT2/pT3a) in 34 patients (71%) and extravesical disease (pT3b/pT4) in 14 (29%). Of the 48 patients, 12 (25%) had lymph node involvement. The mean number of nodes removed was 14 (range 4 to 24). At a mean follow-up period of 38 months (range 10 to 72), 35 patients were alive with no evidence of disease (disease-free survival rate 73%). Conclusions: The results of our study have shown that laparoscopic radical cystectomy is a safe, feasible, and effective alternative to open radical cystectomy. Extracorporeal urinary diversion through a small incision decreases the operating time, while maintaining the benefits of laparoscopic surgery. The 3-year oncologic efficacy was comparable to that of open radical cystectomy. Editorial Comment The advantage of decreased blood loss provided by laparoscopy seems to be a major beneficial aspect of this approach compared to open surgery. This could be due to the insufflation, as well as, magnified vision that can provide better exposure of the anterior retropubic and posterior retrovesical dissection fields facilitating hemostasis. Another major advantage of laparoscopy in radical cystectomy is the smaller skin incision to remove the bladder without prolonged overstretching of the tissues, possibly decreasing postoperative pain.
Journal of Endourology, 2012
We report our initial experience with the first series of laparoendoscopic single-site (LESS) radical cystectomy and urinary diversion performed by a single surgeon using a homemade single-port device at a single institution in China. Between December 2010 and February 2011, we performed five LESS radical cystectomis using a homemade single-port device composed of an inverted cone device of polycarbonate and a powder-free surgical glove. The port was placed into a 5-cm periumbilical incision. The conventional laparoscope and laparoscopic instruments were inserted through the single-port. No additional ports were needed for radical cystoprostatectomy and bilateral standard pelvic lymphadenectomy. Cutaneous ureterostomy and ileal conduit urinary diversion were used for our patients, respectively. Perioperatively, oncologic data and complications were collected and analyzed. All the procedures were completed successfully. The mean extirpative operative time was 208.2 (168-280) minutes, estimated blood loss was 270 (100-500) mL, bowel recovering time was 9.75 (6-12) days, and postoperative hospital stay was 19.5 (14-28) days. One patient needed a transfusion of 400 mL of red blood cells. The pathologic evaluation revealed negative margins and negative lymph node involvement. After the operations, one patient had a bowel obstruction, while another patient died from cardiac disease. Mean follow-up time was 143 (110-173) days. In our experience, LESS radical cystectomy is clinically feasible and safe for selected patients, but requires a learning curve. Our homemade single-port device is a cost-effective and convenient device. Although the initial outcomes have been promising, the long-term oncologic evaluation of these patients awaits.
Urology, 2007
OBJECTIVES Techniques for laparoscopic radical cystectomy are rapidly evolving. The entire procedure can be performed completely intracorporeally by pure laparoscopic techniques or by open-assisted laparoscopic techniques in which the urinary diversion is constructed extracorporeally by way of a minilaparotomy incision. We retrospectively evaluated the outcomes of these two techniques with a focus on perioperative outcomes and associated morbidity. METHODS From December 1999 to March 2006, 54 patients underwent laparoscopic radical cystectomy for muscle invasive (n ϭ 35) or high-risk non-muscle-invasive (n ϭ 19) bladder cancer. The mean follow-up was 25 months (range, 1 to 66 months). RESULTS Of the 54 patients, 17 underwent a pure laparoscopic (group 1, 8 conduit and 9 neobladder) and 37 underwent an open-assisted laparoscopic (group 2, 18 conduit and 19 neobladder) procedure. No significant differences were noted between the groups in patient age, comorbidities, or pathologic stage of malignancy. Group 2 was superior with regard to operative time, blood loss, transfusion rate, time to oral intake, time to ambulation, and postoperative complications (P Ͻ0.05 for all comparisons). Anastomotic leak, bowel obstruction, or sepsis requiring reexploration developed in 5 patients (29%) in group 1 and 4 patients (11%) in group 2. A "learning curve" was observed for both procedures, but it was particularly steep for the pure laparoscopic technique, and this approach was eventually abandoned. CONCLUSIONS Laparoscopic radical cystectomy is associated with a learning curve, with morbidity largely resulting from the urinary diversion procedure. Our experience suggests that the open-assisted laparoscopic approach is technically more efficient and associated with a quicker recovery profile and decreased complication rates compared with the pure laparoscopic approach. UROLOGY
Laparoscopic Radical Cystectomy: Initial Series and Analysis of Results
European Urology Supplements, 2006
We present our series of laparoscopic radical cystectomies. The program was started when our department had a previous experience of nearly 500 laparoscopic radical prostatectomies, which allowed this series to be performed with virtually no learning curve. Methods: From January 2005 to May 2006, we performed 35 laparoscopic radical cystectomies in 8 women and 27 men. Because of the high rate of ureterointestinal stenosis detected in the first 26 cases (19.2%, 5 of 26), we changed from open to laparoscopic urinary diversion. With this change, the rate has currently decreased to 14.2% (5 of 35). Results: Mean surgical time was 5.59 h for open urinary diversion and 9.42 h for pure laparoscopic surgery, with a mean blood loss of 488.57 ml and a mean hospital stay of 14.11 d. The mean number of nodes at lymphadenectomy was 13.5 (range: 5-24) and 37.1% of patients had lymph node involvement. Conclusions: Radical cystectomy is one of the most aggressive urologic surgeries, but numerous publications have shown that it can benefit from the advantages of laparoscopy. The question of whether open or laparoscopic methods are preferable for urinary diversion remains a subject of debate.
Laparoscopic radical cystectomy with and without orthotopic bladder replacement
Minimally Invasive Therapy & Allied Technologies, 2005
The successful introduction of laparoscopic radical prostatectomy at the end of the last millennium represented a quantum leap in the technical development of minimally invasive surgery in urology. Therefore it seemed a logical step that, at the beginning of this millennium, first centers reported their initial experience with laparoscopic radical cystectomy. Based on more than 2000 laparoscopic radical prostatectomies, two centers have performed this procedure in 48 patients including a variety of urinary diversion (i.e. ileal conduit, ileal neobladder, sigmoid neobladder). In this article, all important surgical steps of laparoscopic radical cystectomy are presented, including the description of the most important techniques of urinary diversion. Based on our own experience, the results of 238 cases presented in the current literature are reviewed. The operating time mainly depended on the type and technique of urinary diversion and ranged between 352 and 430 minutes for ileal conduit, and between 478 and 649 minutes for orthotopic neobladder. The complication rate ranged between 16 and 18%, and the reintervention rate was 4-6%. Long-term follow-up is not available, disease-free survival after three years in a limited number of series ranges between 50 and 67%. No port site metastases have been reported so far. Even for the experienced surgeon laparoscopic radical cystectomy with urinary diversion represents a technically challenging procedure. Nevertheless, feasibility and safety have been proved by various authors. However, larger studies with long-term clinical outcome are necessary to determine the final value of the procedure.
Complications in laparoscopic radical cystectomy: The South American experience with 59 cases
International braz j urol, 2006
Objective: In this study, we have gathered the second largest series yet published on laparoscopic radical cystectomy in order to evaluate the incidence and cause of intra and postoperative complication, conversion to open surgery, and patient mortality. Materials and Methods: From 1997 to 2005, 59 laparoscopic radical cystectomies were performed for the management of bladder cancer at 3 institutions in South America. Twenty nine patients received continent urinary diversion, including 25 orthotopic ileal neobladders and 4 Indiana pouches. Only one case of continent urinary diversion was performed completely intracorporeally. Results: Mean operative time was 337 minutes (150-600). Estimated intraoperative blood loss was 488 mL (50-1500) and 12 patients (20%) required blood transfusion. All 7 (12%) intraoperative complications were vascular in nature, that is, 1 epigastric vessel injury, 2 injuries to the iliac vessels (1 artery and 1 vein), and 4 bleedings that occurred during the bladder pedicles control. Eighteen (30%) postoperative complications (not counting mortalities) occurred, including 3 urinary tract infections, 1 pneumonia, 1 wound infection, 5 ileus, 2 persistent chylous drainage, 3 urinary fistulas, and 3 (5%) postoperative complications that required surgical intervention (2 hernias-one in the port site and one in the extraction incision, and 1 bowel obstruction). One case (1.7%) was electively converted to open surgery due to a larger tumor that precluded proper posterior dissection. Two mortalities (3.3%) occurred in this series, one early mortality due to uncontrolled upper gastrointestinal bleeding and one late mortality following massive pulmonary embolism. Conclusions: Laparoscopic radical cystectomy is a safe operation with morbidity and mortality rates comparable to the open surgery.