PTU - Polskie Towarzystwo Urologiczne
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Laparoscopic radical cystectomy: experience in 16 consecutive cases
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Piotr Chłosta, Artur A. Antoniewicz, Jarosław Jaskulski, Paweł Orłowski, Mateusz Obarzanowski, Paweł Olejniczak, Jakub Dobruch, Andrzej Borówka
Oddział Urologii, Świętokrzyskie Centrum Onkologii w Kielcach
Klinika Urologii CMKP I Zespół Dydaktyki Urologicznej – Oddział Urologii Miedzyleskiego Szpitala Specjalistycznego w Warszawie

summary

Introduction.

The development of endovision techniques in urology makes possible to perform laparoscopic radical cystectomy (LAP-CR).

Objectives.

Aim of the study is to present the operative parameters based on first 16 laparoscopic radical cystectomies in the management of invasive bladder cancer.

Materials and methods.

From February 2006 to January 2008 we performed 16 LAP-CRs in the 16 consecutive cases of locally advanced bladder cancer (cT2-3N0M0). Their mean age was 65.4 years (range 55-72). The percentage of laparoscopic procedures was the 29% of all preformed radical cystectomies in the management of invasive bladder cancer. We insert both 5 mm trocars and 3 trocars of 10 mm. In males the procedure was started from dissection of seminal vesicles and posterior surface of the prostate. The both ureters are divided; bladder ligaments and vessels are supplied with the Ligasure® system, bipolar scissors, forceps, metal and plastic clips. Than the procedure is continued from section of Retzius space, incision of pelvic fascia, dissection of the apex and section of urethra. The postoperative specimen is removed in the silicon bag together with iliac and obturator lymph nodes. In female, procedure is started from dissection of uterus ligaments and peritoneum in Douglas cavity. Bladder
with the urethra, uterus, adnexes and anterior vaginal wall was removed transvaginally. After closing the vagina, obturator and iliac lymph nodes were removed. Ileal conduit urinary diversion was performed via minilaparotomy technique, after left ureter passage to the right side under the sigmoid colon mesentery. In one patient, ureterocutaneostomy was performed because simultaneous right nephroureterectomy in case of ureterohydronephrosis and lack of kidney function. After the surgery, one suction drain 14F was left in abdominal cavity.

Results.

In 15 patients the procedure was preformed laparoscopically. In one case, because of technical difficulties, conversion to standard, open technique was necessary. In one case, sigmoid colon injury was found intraoperatively, and successfully treated by laparoscopic suturing. Except this, there was no other complication during LAP-CR. After surgery a 14 F suction drain was introduced via 5 mm trocar. The mean time of the surgery was 290 min (270-340 min). The mean blood loss during LAP-CR was 220 mL (from 190 to 550 mL). Blood transfusion was necessary in two cases of LAP-CR. In two cases the short-term paralytic ileus was found on
the second day after surgery. One patient developed leakage of ileal anastomosis in the sixth day after LAP-CR, and he was operated successfully with laparotomy technique. There was no other postoperative complication. Surgical outcome based on back to vital activity and hospitalization time was 2 and 6 (5-8) days respectively, and was significantly shorter than after standard, open procedure (p <0.001). Histopathological examinations of postoperative specimens indicate transitional cell cancer in 10 (62.5%) patients, concomitant transitional and squamous cell cancer in 5 (31.25%) patients and squamous cell cancer in one (6.25%). Pathological stage of the tumour was pT2b, pT3a and pT3b in 6 (37.5%), 7 (43.75%) and 3 (18.75%) patients respectively. Three patients (18.75%) had active tumor in the resected lymph nodes.

Conclusions.

LAP-CR is an effective and considerably less invasive procedure from open radical cystectomy. LAP-CR is technically demanding surgical procedure in the management of invasive bladder cancer. The ‘learning curve’ of the LAP-CR in team with experience of laparoscopic surgery is significantly shorter, than we judged before introduction this technique into routine procedure.