Laparoscopic Radical Cystectomy with Orthotopic Neobladder

Abdel-Hakim, Amr M.; Bassiouny, Fahim; Azim, Mohamed Salah Abdel; Rady, Ismail; Mohey, Tarek; Habib, Inmar; Fathi, Hesham

doi:10.1089/089277902760261428

Cited by 56 publications

(17 citation statements)

References 5 publications

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“…Advances in surgical technique and improved instrumentation have allowed complex surgeries, such as radical prostatectomy, to be performed laparoscopically and even using robots 5 . Therefore, it is not surprising that endeavours are being made to perform radical cystectomy laparoscopically 5–12 . We prospectively evaluated laparoscopy‐related complications in the initial 11 laparoscopic radical cystectomies we performed and discuss the outcome.…”

Section: Introductionmentioning

confidence: 99%

Complications of laparoscopic radical cystectomy during the initial experience

et al. 2004

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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.

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Section: Introductionmentioning

confidence: 99%

Complications of laparoscopic radical cystectomy during the initial experience

et al. 2004

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“…The procedure of laparoscopic radical cystectomy has been reported in various series with minor modifications [5,9,19–21]. It is complicated and technically challenging requiring a detailed knowledge of pelvic anatomy and bladder cancer pathology.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic extended pelvic lymph node dissection during radical cystectomy: technique and clinical outcomes

Shao

Meng

et al. 2010

BJU International

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Study Type – Therapy (case series)  Level of Evidence 4 What’s known on the subject? and What does the study add? Pelvic lymph node dissection (PLND) is an obligatory step for radical cystectomy and it provides staging information and potential survival benefits. This study shows extended PLND with proximal boundary of inferior mesentery artery is safe and feasible under laparoscopy. More positive nodes can be retrieved compared to standard template. OBJECTIVE • To study the surgical techniques and clinical results of laparoscopic extended pelvic lymph node dissection during radical cystectomy. PATIENTS AND METHODS • From July 2007 to October 2009, 43 patients with bladder carcinoma received laparoscopic radical cystectomy with extended pelvic lymphadenectomy and urinary diversion. • Pelvic lymph node dissection (PLND) was first performed within extended template. • The lower part of aorta and vena cava were isolated from the bifurcation of common iliac artery to the level of the inferior mesenteric artery. • The standard template PLND was continued along the external iliac vessels, internal iliac vessels and obturator nerve. The bladder was then removed laparoscopically and urinary diversion was performed. RESULTS • All procedures were performed successfully and no open conversion occurred. The duration of the procedure for extended PLND was 90–185 min (mean 125 min) and total duration was 280–470 min (mean 329 min). • Intra‐operative blood loss was 200–1500 mL (mean 325 mL) and eight cases received transfusion. Pathological study identified transitional cell carcinoma and a negative margin in all cases. A range of 19–53 lymph nodes were dissected in the patients with a mean of 31.3. • In total, 17 positive nodes were confirmed in 11 cases. Postoperative complications included two cases of bowel obstruction, two cases of mild urine leakage and 17 cases of lymphatic leakage. CONCLUSIONS • Laparoscopic radical cystectomy with extended pelvic lymphadenectomy is indicated in selected patients with bladder cancer. • It is safe, minimally invasive and more lymph nodes can be retrieved with a higher success rate by extended pelvic lymphadenectomy.

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“…Additional case reports followed in the mid-1990s [16]. The first larger series with n = 9 (Abdel-Hakim et al [18]), n = 10 (Hemal et al [17]), and n = 14 (Menon et al [11]) patients were presented at the beginning of the twenty-first century. Gill et al [19] published results on laparoscopic cystectomy with intracorporeal suture of the enteroanastomosis and complete urinary diversion in 2000.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic radical cystectomy: initial experience on 27 consecutive patients

et al. 2007

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Recent reports have demonstrated that robot-assisted laparoscopic cystectomy is technically feasible. We report technical and functional results of a large series of patients undergoing laparoscopic cystectomy with the da Vinci surgical system (DVSS). A total of 27 patients (24 males) underwent laparoscopic radical cystectomy with the DVSS (intuitive surgical) between January 2004 and December 2005. Indications for cystectomy were muscle-invasive transitional cell carcinoma (TCC) or leiomyosarcoma of the urinary bladder (n = 24) and bladder shrinking following prior radiotherapy for TCC. A pelvic lymphadenectomy was a routine part of the procedure. Urinary diversions were ilieal conduits (n = 19) and ileal neobladders (n = 8). Mean operating time was 340 min (range 150–450) with a mean blood loss of 301 ml (range 50–550). The mean number of lymph nodes retrieved during lymphadenectomy was 23. Surgical margins were negative except in one case. After a mean follow-up of 10.2 months, two perioperative (anastomotic leakage, adhesions) and three postoperative complications (ileus, intestinal fistula, urinary tract obstruction) occurred. Six out of seven patients reported satisfying erectile function following nerve-sparing surgery. Day-time continence was completely restored after a mean 3.5 months in seven of eight patients. Robot-assisted laparoscopic cystectomy is a safe procedure. Satisfying functional and oncological short-term results can be achieved within acceptable operating time limits.

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Laparoscopic Radical Cystectomy with Orthotopic Neobladder

Cited by 56 publications

References 5 publications

Complications of laparoscopic radical cystectomy during the initial experience

Complications of laparoscopic radical cystectomy during the initial experience

Laparoscopic extended pelvic lymph node dissection during radical cystectomy: technique and clinical outcomes

Robot-assisted laparoscopic radical cystectomy: initial experience on 27 consecutive patients

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