Laparoscopic Radical Cystectomy and Extracorporeal Urinary Diversion: A Single Center Experience of 48 Cases with Three Years of 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...
Arab journal of urology, 2014
Objectives: To assess the feasibility, operative morbidity and oncological outcome of laparoendoscopic single-site (LESS) radical cystectomy. Patients and methods: Ten patients with clinical stage T1-T2 bladder cancer underwent a LESS radical cystectomy. The mean (SD) age of the patients was 64.8 (8.6) years and their mean body mass index was 25.9 (2.7) kg/m 2. The procedure was done via a single-incision laparoscopic surgery port using a rigid 5-mm 30°longshaft laparoscope in addition to the two working instruments. A 7-cm Pfannenstiel incision was made to remove the specimens and to allow the creation of an ileal neobladder with hand assistance. Results: In eight patients the LESS radical cystectomy was completed as scheduled, with the other two requiring a conversion, one to an open procedure due to locally advanced disease, and the other to conventional laparoscopy due to gas leakage. The mean (SD) operative duration was 236 (49) min, with a mean estimated blood loss of 575 (113) mL, and a mean hospital stay of 5.5 (0.7) days. No postoperative analgesic medications were prescribed and patients returned to normal activity after a mean
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.
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.
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.
The Journal of Urology, 2005
Objectives. To present our experience with the first series of rectosigmoid pouch creation performed completely laparoscopically for continent urinary diversion after radical cystectomy to treat transitional cell carcinoma of the bladder. We evaluated the intermediate functional and oncologic outcomes. Methods. Between April 2000 and January 2004, 20 patients underwent laparoscopic radical cystectomy with urinary diversion for transitional cell carcinoma at the Department of Urology, Charité Hospital, Campus Mitte. Of the 20 patients, 12 received a rectosigmoid pouch for urinary diversion. The procedures were performed completely laparoscopically, including free-hand laparoscopic suturing and in situ knot tying techniques. The mobilized specimens were removed in an endoscopy bag by way of the rectum or vagina. Results. All operations were completed laparoscopically by two surgeons without conversion to open surgery. The median operating time was 485 minutes. One patient needed a blood transfusion of 2 U. All specimens had negative surgical margins. Two patients required reoperation. The median follow-up was 33 months. All patients were continent during the day, and 11 patients were continent at night. One patient developed unilateral hydronephrosis with loss of kidney function. No patient developed local recurrence, but 3 patients had systemic progression. Two of the three died of metastatic disease. Conclusions. This is the first series of laparoscopic radical cystectomy using an intracorporeal rectosigmoid pouch. Our functional data for continence and upper urinary tract obstruction were comparable with those of open rectosigmoid pouch studies. We were able to demonstrate an oncologic outcome similar to that achieved by the open surgical approach. UROLOGY 64: 935-939, 2004.