Complications of laparoscopic radical cystectomy during the initial experience

Abstract

Aim : Radical cystectomy is the standard of care for patients with muscle invasive bladder cancer. While open radical cystectomy is now a standard procedure, laparoscopic radical cystectomy is still in its infancy. We performed this surgery laparoscopically in 11 patients and review the procedure specific complications. Methods : Beginning in February 1999, 11 patients underwent laparoscopic radical cystectomy at the Department of Urology, All India Institute of Medical Sciences, New Dehli. Urinary diversion was performed by an open-hand sewn ileal conduit.Results : There were three intraoperative complications specifically related to the laparoscopic radical cystectomy. These included injury to the external iliac vein in one patient and a small rectal tear in two. All were repaired with laparoscopic free hand suturing with normal postoperative recovery.Other laparoscopy-related complications were subcutaneous emphysema in one patient and hypercarbia necessitating conversion to open surgery in a patient who, four weeks after surgery, died of multiple organ failure. One patient had margins positive and received cisplatinum-based chemotherapy. All patients had normal renal function and preserved upper tracts with no evidence of metastasis at a mean of 18.4 months follow up (range 1-48 months). Conclusions : Though there were three complications specific to the laparoscopic radical cystectomy, none necessitated a conversion to open surgery or hampered the overall outcome. Absence of local recurrence or metastatic disease at four years of follow up suggests that the procedure is oncologically valid. Laparoscopic radical cystectomy is a new procedure and it is important to critically analyze the complications in order to reduce their occurrence and allow the development of a better technique.

Complications in laparoscopic radical cystectomy: The South American experience with 59 cases

“…In our series, the overall incidence of complications was 42%, being 7 intraoperative (12%) and 18 postoperative (30%), which is comparable to the 30.5% of complications (only postoperative complica- tions) that were found after studying 2,538 subjects that underwent open radical cystectomy, with ileus in 9.7%, urinary tract infection in 7.8%, dehiscence in 5.5%, wound infection in 5.2%, and postoperative hemorrhage in 1.8%, requiring transfusion greater than 4 units within 72 hours postoperatively (8). In fact, in a review of 152 laparoscopic radical cystectomies performed at 5 centers, the mean operative time was 398 minutes and the mean blood loss was 605 mL (7,(9)(10)(11)(12). Twenty eight complications occurred (18.5%), including 1 dehydration, 1 obturator nerve paresis, 1 pelvic infection, 4 urinary tract infection, 1 injury to the external iliac vein, 1 subcutaneous emphysema in one patient with hypercarbia, 2 pulmonary embolism, 5 urinary fistulas (1 case of neobladder to vagina fistula), 3 hematomas, 1 ureteral obstruction secondary to misplaced ureteral catheter, 1 bladder neck contracture, 1 epididymal abscess, 1 wound dehiscence, 1 internal hernia requiring laparotomy 19 days postoperatively, 2 small rectal tears and 2 partial small bowel obstruction.…”

First case series of robotic radical cystoprostatectomy, bilateral pelvic lymphadenectomy, and urinary diversion with the da Vinci S system

“…Histopathology revealed transitional cell carcinoma in all the patients (pT2a-1, pT2b-3, pT3a-2). The mean number of nodes removed was 12 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). One patient had a node-positive disease.…”

“…LRC is a technically demanding procedure with a steep learning curve. It is associated with some major complications during the initial part of the learning curve [12]. The most technically challenging part of the surgery is the urinary diversion particularly if it is done completely intracorporeally [13].…”

Robot-assisted radical cystoprostatectomy in the post-radiation and chemotherapy patient

“…The technical diYculty of the pure laparoscopic approach and the high rate of complications during the beginning of the learning curve have limited use of this technique [7]. Use of robot-assisted laparoscopy eVectively reduces the learning curve for the procedure, thus expanding its applicability.…”