Laparoscopic Radical Cystectomy with Urinary Diversion in Ramathibodi Hospital
Keywords:
Radical cystectomy, Laparoscopy, Ileal conduit, neobladder diversionAbstract
Purpose: The gold standard of care for patients with muscle invasive bladder cancer is radical cystectomy. While open radical cystectomy is now a standard procedure, laparoscopic radical cystec- tomy is still an alternative procedure. We reported our experience on surgical technique and outcome for laparoscopic radical cystectomy with urinary diversion.
Methods: A retrospective review was performed of 23 patients who required radical cystectomy and urinary diversion, which 20 cases for the ileal conduit (group 1), 3 cases for neobladder (group 2) at our institution between 2005-2006. Inclusion criteria was invasive cancer of urinary bladder which invade at least to muscular layer. Exclusion criteria were those had distance metastatic bladder cancer or absolute contraindications for general anesthesia or laparoscopic procedure. We used the five-port transperitoneal approach for radical cystectomy and opend the small incision about 5 cm for retrieving the specimen and the ileal reconstruction (conduit or neobladder) were performed extracorporeal through the same small lower abdominal incision. We have performed the operation by the same team and we reported total operating time (hours), radical cystectomy time (hours), estimated blood loss (cc), hospital stay (days), and complications
Results: The respective total operating time (hours), radical cystectomy time (hours), estimated blood loss (cc), hospital stay (days) in group 1 and group 2 were 6.3/6.6 hours, 2.5/2.75 hours, 534/250 cc , 17/24.6 days. One patient in group 1 had compartment syndrome of right leg.
Conclusions: The laparoscopic radical cystectomy remained challenging procedure for laparoscopic urologist. Even the advantage of blood loss, shorten hospital stay and decreased postoperative pain in laparoscopic procedure, we must regard to the difficult of the procedure and the long-term oncologic followup data will determine.
References
Belldegrun A, deKernion JB, Litwin MS, Pantuck A, Reiter RE, Smith RB. Urological conditions and treatments- Bladder cancer. WWW.uclaurology.com/conditions/bladd1.cfm
Dalbagni G, Genega E, Hashibe M, Zhang ZF, Russo P, Herr H, et al. Cystectomy for bladder cancer: a contemporary series. J Urol 2001; 165: 1111- 6.
Kittinut K, Suthep P, Wisoot K, Charuspong D. Laparoscopic Radical Cystectomy with Ileal Conduit Diversion: The First Case Report in Thailand. J Med Assoc Thai 2005; 88 (12): 1947-51.
Gill IS, Fergany A, Klein EA, Kaouk JH, Sung GT, Meraney AM, et al. Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology 2000; 56: 26-9.
Gill IS, Kaouk JH, Meraney AM, Desai MM, Ulchaker JC, Klein EA, et al. Laroscopic radical cystectomy and continence orthotopic nepbladder performed completely intracorporeally: The initial experience. J Urol 2002; 168: 13-8.
Basillote JB, Abdelshehid C, Ahlering TE, Shanberg AM. Laparoscopic assisted radical cystectomy with ileal neobladder: A comparison with the open approach. J Urol 2004; 172: 489-93.
Studer UE, Ackermann D, Casanova GA, Zingg EJ. A newer form of bladder substitute based on historical perspectives. Semin Urol 1998, 6: 57-65.
Parra RO, Andrus CH, Jones JP, Boullier JA. Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol 1992; 148: 1140-4.
Sanchez de Badajoz E, Gallego Perales JL, Reche Rosado A, Gutierrez de la Cruz JM and Jimenez Garrido A. Laparoscopic cystectomy and ileal conduit: case report. J Endourol 1995; 9: 59-62.
Abdel-Hakim AM, Bassiouny F, Abdel Azim MS, Rady I, Mohey T, Habib I, et al. Laparoscopic radical cystectomy with orthotopic neobladder. J Endourol 2002; 16(6):377-81.11. 12.
Carvalhal EF, Gill IS. Laparoscopic cystectomy: indications and limitations. Archivos Espanoles de Urologia 2002; 55(6):721-9.
Kaouk JH, Gill IS, Desai MM, Meraney AM, Fergany AF, Abdelsainea A, et al. Laparoscopic orthotopic ileal neobladder. J Endourol 2001; 15: 131-42.
Valdivia Uria JG, Viloria Gonzalez A, Rodriguez Gomez J, Valle Gerhold J, Martinez Sanudo MJ, Whyte Orozco A, et al. Laparoscopic cystoprostatovesiculectomy and ureterosigmoidostomy. Experimental surgical model. Actas Urol Esp 1992; 16: 592-8.
Anderson KR, Fadden PT, Kerbl K, McDougall EM, Clayman RV. Laparoscopic assisted continent urinary diversion in the pig. J Urol 1995; 54: 1934-8.
Fergany AF, Gill IS, Kaouk JH, Meraney AM, Hafez KS, Sung KT. Laparoscopic intracorporeally constructed ileal conduit after porcine cystoprostatectomy. J Urol 2001; 166: 285-8.
Kozminski M, Partamian KO. Case report of laparoscopic ileal conduit. J Endourol 1992; 6: 147-150.
Puppo P, Perachino M, Ricciotti G, Bozzo W, Gallucci M, Carmignani G. Laparoscopically assisted transvaginal radical cystectomy. Eur Urol 1995; 27: 80-4.
Denewer A, Kotb S, Hussein O, El-Maadawy M. Laparoscopic assisted cystectomy and lymphadenectomy for bladder cancer: initial experience. World J Surg 1999; 23: 608-11.
Potter SR, Charambura TC, Adams JB, 2nd and Kavoussi LR. Laparoscopic ileal conduit: five-year follow-up. Urology 2000; 56: 22-5.
Turk I, Deger S, Winkelmann B, Schonberger B, Loening SA. Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: the initial 5 cases. J Urol 2001; 165: 1863-6.
Hemal AK, Kolla SB. Comparison of Laparoscopic and Open Radical Cystoprostatectomy for Localized Bladder Cancer With 3-Year Oncological Followup: A Single Surgeon Experience. J Urol 2007; 178: 2340-43.
Simms MS, Terry TR. Well Leg Compartment Syndrome after Pelvic and Perineal Surgery in the Lithotomy Position. Postgrad Med J 2005; 81: 534-6.
