Piotr Chłosta, Artur A. Antoniewicz, Jarosław Jaskulski, Paweł Orłowski, Mateusz Obarzanowski, Jakub Dobruch, Andrzej Borówka
- Oddział Urologii, Świętokrzyskie Centrum Onkologii w Kielcach
Klinika Urologii CMKP I Zespół Dydaktyki Urologicznej – Oddział Urologii Międzyleskiego Szpitala Specjalistycznego w Warszawie
Introduction. The development of endovision techniques in urology makes possible to perform laparoscopic radical cystectomy in invasive bladder cancer patients.
Objectives. Aim of the video is to present the operative technique of laparoscopic radical cystectomy(LAP-CR).
Materials and methods. The video was realized after team experience based on LAP-CR performed from February 2006 to January 2008 in 16 cases of invasive bladder cancer (15 males and 1 female). 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 performed 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.
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. Using bipolar instruments and Ligasure® system facilitates the operation and makes LAP-CR possible to be performed efficiently and safely, especially in cases of absence of extravesical cancer expansion.a