Extracorporeal Reconstruction Research Articles

A Modified Purse-String Stapling Technique for Intracorporeal Circular Stapled Esophagojejunostomy During Laparoscopic Total Gastrectomy: Comparison with Extracorporeal Reconstruction Technique.

Background: Intracorporeal esophagojejunostomy (EJ) in the context of laparoscopic total gastrectomy remains a complex and technically demanding procedure. We have previously introduced a novel method of intracorporeal circular stapled EJ utilizing a conventional purse-string suture instrument. Since May 2018, we have refined this technique, and the aim of this study was to assess its safety and efficacy. Methods: Between May 2018 and June 2022, we enrolled 92 patients who underwent laparoscopic total gastrectomy with the modified intracorporeal reconstruction method. In addition, between March 2014 and June 2022, we enrolled 121 patients who underwent the procedure with the extracorporeal reconstruction method. We retrospectively collected and compared the clinical data of these 2 patient cohorts. Results: Intracorporeal reconstruction group experienced lower postoperative pain scores (2.7 ± 1.3 versus 4.5 ± 1.4, P = .032), reduced administration of analgesics (3.1 ± 2.2 versus 5.0 ± 3.5, P = .041), and shorter postoperative hospital stays (4.9 ± 2.3 versus 6.3 ± 3.5, P = .045) compared with the extracorporeal reconstruction group. In addition, anastomotic time and postoperative pain score were not increased in the overweight patients in the intracorporeal reconstruction group. Anastomotic leakage occurred in 2 (2.2%) patients in the intracorporeal reconstruction group and 4 (3.3%) patients in the extracorporeal reconstruction group. Anastomotic stricture occurred in 1 (1.1% and 0.8%) patient in each group. There was no significant difference in the overall postoperative complication rate between the 2 groups. Conclusions: The modified intracorporeal purse-string stapling technique for EJ during laparoscopic total gastrectomy is a safe and viable option, exhibiting less invasiveness and comparable outcomes to the extracorporeal reconstruction method, especially suitable for obese patients.

Extracorporeal Reconstruction of the Radial Head

Radial head fractures are common in adults. The radial head acts as an important stabilizer of the radius, especially during the forearm pronation and supination. Surgical treatment of Mason type III fracture of the radial head includes radial head excision, radial head replacement and open reduction and internal fixation. For patients treated with radial head excision, the radius might migrate proximally, causing complications such as chronic pain at the wrist, forearm, and elbow. On the other hand, radial head arthroplasty is associated with a high revision and removal rate. Hence, openreduction and internal fixation are preferred when feasible. This is technically demanding due to the severe displacement of the radial head fragments and limited surgical space. Mr K, a 30-year-old manual worker sustained a closed right radial head fracture Mason type III after an alleged fall. The radial head was displaced anteriorly. Intra-operatively, the radial headpieces were retrieved and were reconstructed extracorporeal and fixed with a miniplate. The patient subsequently recovered with good function. The new technique of extracorporeal reconstruction of the radial head offers a viable option to the surgeon with similar, or even better, outcomes in terms of elbow function.

Chinese expert consensus on intracorporeal digestive reconstruction after robotic gastrectomy (2021 edition)

The robotic surgical system applied to gastrectomy is regarded as a safe technique which has similar short- and long-term outcomes compared to laparoscopic and open gastrectomy. With the iteration of anastomotic staplers and improvement of anastomotic skills, coupled with the flexible robot's rotatable device making the manual intracorporal anastomosis easier, gastrointestinal reconstruction after robotic gastrectomy has also started to move toward the era of complete intracorporal anastomosis. In order to further standardize the indications and operating points, the Upper Gastrointestinal Surgery Group of Surgical Branch of Chinese Medical Doctor Association, the Gastrointestinal Surgery Group of Surgery Branch of Chinese Medical Association, the Digestive Tract Cancer Committee of Chinese Research Hospital Association, and Cancer Gastroenterology Society of Chinese Anticancer Association jointly organized domestic experts in general surgery field to formulate the Chinese expert consensus on intracorporal digestive reconstruction after robotic gastrectomy (2021 edition). The definition of intracorporeal digestive reconstruction after robotic gastrectomy is that all surgical steps of digestive reconstruction are done totally in the abdominal cavity by robotic system or all steps mentioned above except jejunojejunal extracorporeal anastomosis. The digestive reconstructions mainly include Billroth I anastomosis, Billroth II anastomosis, Billroth II+ Braun anastomosis, Roux-en-Y anastomosis, Uncut Roux-en-Y anastomosis after distal gastrectomy; double-tract anastomosis, esophagogastric anastomosis by stapler or hand-sewn technique (double flap gastroesophagostomy) after proximal gastrectomy; FEEA method, π-type anastomosis, overlap method and modified procedures, Uncut Roux-en-Y anastomosis, Parisi's double-loop reconstruction after total gastrectomy. Compared with extracorporeal digestive reconstruction, intracorporeal digestive reconstruction operated by robotic system can minimize the surgical incision, reduce the risk of abdominal exposure and accelerate postoperative recovery, etc. Previous studies have demonstrated promising results. We believe that the publication of the consensus will guide surgeons to break through the technical barriers of intracorporeal digestive reconstruction after robotic gastrectomy, which will be more and more widespread with the gradual maturity of domestic robotic systems by bringing less medical costs.

Comparing open-radical cystectomy and robot-assisted radical cystectomy: current status and analysis of the evidence.

Radical cystectomy is the definitive surgical treatment for aggressive bladder cancer. The robotic platform offers a new approach to radical cystectomy, but the benefits are unclear. This review examines the latest evidence, with a particular focus on developments in the last two years. Prospective evaluations of open (ORC) and robot-assisted radical cystectomy (RARC) are emerging. The radical cystectomy in patients with bladder cancer trial reported in 2018 and demonstrated oncological noninferiority for both approaches and marginal shorter length of stays with RARC using an extracorporeal reconstruction. The trial confirmed prospective randomized comparisons are possible, and replicates observations from two earlier, smaller randomised controlled trials with longer follow-up. Although there has been significant traction to the intracorporeal approach to RARC, randomized trial evidence is awaited to show any benefit over ORC. New evidence alludes to the noninferiority of the robotic platform in radical cystectomy in comparison to open surgery. There is minimal evidence of a clinically meaningful benefit. Until this is addressed, ORC remains the gold standard for the definitive surgical management of bladder cancer.

Modified U-Shaped ileal neobladder designed for facilitating neobladder-urethral anastomosis in extracorporeal reconstruction after robotic-assisted radical cystectomy.

To report the initial experience and the early outcomes of a modified U-shaped ileal neobladder, which was developed to facilitate the neobladder-urethral anastomosis by minimizing the anastomotic tension. Between June 2015 and December 2016, two male and two female patients (median age: 65.5 years, range: 43-72 years) underwent the modified U-shaped ileal neobladder after robotic-assisted radical cystectomy (RARC). The most mobile and dependent ileal segment was first selected intracorporeally as the site for later neobladder-urethral anastomosis. The neobladder was formed extracorporeally, and the previously selected ileal segment formed the most dependent portion of the neobladder. The neobladder-urethral anastomosis was completed after robotic redocking. The median follow-up was 8 months (3-21 months). The median operative time, console time, and extracorporeal reconstruction time were 620 min (534-674 min), 372 min (314-420 min), and 151 min (128-215 min), respectively. In all patients, the neobladder-urethral anastomosis was completed intracorporeally with minimal tension. The median hospital time after the surgery was 14.5 days (14-19 days). Postoperatively, the median peak flow rate and void volume were 10 ml/s (4-35 ml/s) and 258 ml (88-775 ml). The median postvoid residual was 20 ml (10-53 ml). At daytime, two were completely continent; the other two reported mild (1-2 pads) and moderate (>2 pads) incontinence at the postoperative 3 and 4 months, respectively. Three reported nocturnal enuresis. Our initial experience demonstrated that the modified U-shaped neobladder designed for minimizing the anastomotic tension is safe and feasible with its satisfactory functional outcomes.

Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer.

Radical cystectomy remains the gold standard for treatment of muscle‐invasive bladder cancer. Robot‐assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot‐assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high‐volume academic institutions. In the present review, we compare the totally intracorporeal robot‐assisted radical cystectomy approach with open radical cystectomy and robot‐assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle‐invasive bladder cancer patients.

Діаґностика та хірурґічне лікування аневризм ниркових артерій

Aim. Improvement of diagnosis and surgical treatment of renal artery aneurysms.  Material and Methods. The features of the clinical course, diagnosis and surgical treatment of renal artery aneurysm were analyzed in a 55-year-old patient. Results and Discussion. In our observation, in a 55-year-old patient, by clinical examination, laboratory and diagnostic imaging the following diagnosis was confirmed: Atherosclerosis. Aneurysm of the right renal artery. Moderate ectasia of the left renal artery trunk. Condition after stent-graft implantation into the right renal artery (25.06.2018), embolization of a pseudoaneurysm of the right renal artery (22.11.2018). Arterial hypertension, Stage II, risk 4. Presence of a drug-resistant hypertension, a saccular renal artery aneurysm with 2.0 cm in diameter, and unsuccessful attempts to use endovascular methods of treatment have become direct indications for surgical intervention, not only saving patient's life, but also preventing the development of fatal complications. Surgical treatment of the renal artery aneurysms consists of: endovascular interventions (aneurysm embolization, stenting), in situ reconstruction (in-situ prosthesis, tangential resection and angioplasty, nephrectomy), extracorporeal reconstruction - ex vivo. Nephrectomy is recommended in cases of multiple large intrarenal aneurysms, concomitant renal pathology (atrophy, tumor), rupture of aneurysms in patients in a shock condition, and previously unsuccessful reconstructive interventions. Conclusions. Renal artery aneurysm is a rare clinical condition that may be complicated by rupture and fatal bleeding. This clinical case demonstrates that adequate surgical treatment - resection of sac-like aneurysm in vivo allowed not only to prevent the occurrence of life-threatening complications, but also to achieve complete recovery of the patient.

Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (iROC): protocol for a randomised controlled trial with internal feasibility study

IntroductionBladder cancer (BC) is a common malignancy and one of the most expensive to manage. Radical cystectomy (RC) with pelvic lymphadenectomy is a gold standard treatment for high-risk BC. Reductions...

АНЕВРИЗМИ НИРКОВИХ АРТЕРІЙ: ДІАГНОСТИКА ТА ХІРУРГІЧНЕ ЛІКУВАННЯ EX VIVO

Renal artery aneurysm (RAA) is a rare disease that is detected in autopsy in 0.01 – 0.09% as a casual finding. The RAA are divided into: true aneurysms (saccular or fusiform), dissecting aneurysms (from the aorta, only from renal arteries), pseudoaneurysms, intrarenal aneurysms. The causes of RAA include: atherosclerosis, fibro-muscular dysplasia, hypertension, hydronephrosis, Ehlers-Danlos syndrome. In 90% of cases, RAA manifests itself in arterial hypertension. Abdominal pain, paresis of the intestine, the presence of pulsating formation, hematuria may indicate on increase in the size of the aneurysm or their dissection. The use of ultrasound duplex scan, CT, MRI and angiography can confirm the RAA in 0.3-2.5% in high-risk groups. Indications for surgical treatment include: RAA > 2 cm, RAA in women of childbearing age, abdominal or lumbar pain, hematuria, refractory to drug therapy arterial hypertension, functionally significant stenosis of RA with size of RAA > 1cm, thromboembolism, dissection, rupture of RAA. Surgical treatment of the RAA consists of: in situ reconstruction (in-situ prosthesis, tangential resection and angioplasty, nephrectomy), endovascular interventions (aneurysm embolization, stenting), extracorporeal reconstruction – ex vivo. The autotransplantation of the kidney with extracorporeal reconstruction of the renal artery with RAA of the second and third branching is an efficient method of treatment, which provides satisfactory long-term clinical results and is performed in cases when classical reconstruction or endovascular correction is impossible.

Robot-assisted radical cystoprostatectomy: Analysis of the complications and oncological and functional aspects

ObjectivesTo review our experience in robot-assisted radical cystectomy, assessing the complications and oncological and functional results. Materials and methodsFrom 2007 to 2014, we performed 67 robot-assisted radical cystectomies combined with lymphadenectomy in 61 cases. The operations were performed on 37 patients due to muscle-invasive tumors and on 30 due to high-risk nonmuscle-invasive tumors. Urinary diversion was conducted extracorporeally, using a Studer neobladder in 47 cases. ResultsThe mean blood loss was 300mL. No case required conversion to open surgery. The median number of lymph nodes extracted was 16 (range 3–33). Pathology revealed 16 pT0, 15 pTis, -pT1-pTa and 44 muscle-invasive tumors, 8 pN+ and 1 with positive margins. The mean hospital stay was 9 days. With a median follow-up of 16 months, 9 (13%) patients were readmitted after the discharge, most for infections associated with the vesical catheter and other catheters. Forty patients (59.7%) presented complications (most were Clavien grade 1–2). There was recurrence during the follow-up in 4 cases (6%), and 4 (5.9%) patients died from cancer. Nineteen (28.3%) patients had complications after 30 days, most of which were urinary tract infections. Of the 47 patients with a neobladder, 45 (96%) had proper daytime continence and 42 (89%) had proper nighttime continence. Ninety percent and 64% of the patients with previously normal sexual function and reduced sexual function, respectively, were able to preserve sexual function with or without drug treatment. ConclusionsRobot-assisted radical cystectomy plus lymphadenectomy, with extracorporeal reconstruction of the urinary diversion, offers good oncological and functional results without increasing the number of complications.

Cistoprostatectomía radical robótica: análisis oncológico, funcional y de las complicaciones

ObjectivesTo review our experience in robot-assisted radical cystectomy, assessing the complications and oncological and functional results. Materials and methodsFrom 2007 to 2014, we performed 67 robot-assisted radical cystectomies combined with lymphadenectomy in 61 cases. The operations were performed on 37 patients due to muscle-invasive tumours and on 30 due to high-risk nonmuscle-invasive tumours. Urinary diversion was conducted extracorporeally, using a Studer neobladder in 47 cases. ResultsThe mean blood loss was 300mL. No case required conversion to open surgery. The median number of lymph nodes extracted was 16 (range 3-33). Pathology revealed 16 pT0, 15 pTis,-pT1-pTa and 44 muscle-invasive tumours, 8 pN+ and 1 with positive margins. The mean hospital stay was 9 days. With a median follow-up of 16 months, 9 (13%) patients were readmitted after the discharge, most for infections associated with the vesical catheter and other catheters. Forty patients (59.7%) presented complications (most were Clavien grade 1-2). There was recurrence during the follow-up in 4 cases (6%), and 4 (5.9%) patients died from cancer. Nineteen (28.3%) patients had complications after 30 days, most of which were urinary tract infections. Of the 47 patients with a neobladder, 45 (96%) had proper daytime continence and 42 (89%) had proper nighttime continence. Ninety percent and 64% of the patients with previously normal sexual function and reduced sexual function, respectively, were able to preserve sexual function with or without drug treatment. ConclusionsRobot-assisted radical cystectomy plus lymphadenectomy, with extracorporeal reconstruction of the urinary diversion, offers good oncological and functional results without increasing the number of complications.

LAPAROSCOPIC RADICAL CYSTECTOMY WITH ILEAL CONDUIT URINARY DIVERSION, FIRST EXPERIENCE IN BANDUNG

Objective: To report our experience in performing laparoscopic radical cystectomy with ileal conduit urinary diversion (extracorporeal reconstruction). Material & method: This study was take place in Hasan Sadikin Hospital Bandung. A 54-year-old male with histologically proven transitional cell carcinoma of the bladder cT2bN0M0 underwent a laparoscopic radical cystoprostatectomy and ileum dissection was performed under laparoscopy. Ileal conduit and stoma reconstruction performed extracorporeal through small incision between ports (about 4cm). Results: The surgical margins were free of disease. The operative time was 360 minutes. Estimated blood loss was 600cc. Hospital stay was 5 days. Patient was discharge with no complication of post-op wound, and urine production about 1500cc/24hrs via stoma. Conclusion: Laparoscopic radical cystectomy with ileal conduit extracorporeal reconstructive urinary diversion could be the preferred means in managing bladder tumor on selective case.

A novel method for reconstruction of severe caudal nasal septal deviation: Marionette septoplasty.

We conducted a retrospective study to compare open and endonasal (closed) approaches to extracorporeal reconstruction of severe caudal septal deviations. From January 1, 2010, through December 31, 2013, 78 patients with severe caudal septal deviation underwent corrective surgery at our hospital. Of this group, 33 patients (mean age: 32 yr) underwent extracorporeal septoplasty via an open approach, and 45 patients (mean age: 35 yr) underwent treatment with a new procedure that we developed: subtotal extracorporeal septoplasty through a closed approach, which we call "marionette septoplasty." In addition to demographic data, we compiled information on surgical time, the duration of postoperative edema, the degree of postoperative pain, and differences between pre- and postoperative nasal function and tip support in both groups. We found that our marionette septoplasty procedure required significantly less surgical time and resulted in a significantly shorter duration of postoperative edema than did open septoplasty, while there was no statistically significant difference between the two procedures in the degree of pain. Following surgery, nasal function in both groups improved significantly, without any significant difference between the two. Finally, we documented improved tip support in all 78 patients. Our results show that marionette septoplasty produces the same functional results as does open septoplasty while requiring less surgical time and shortening the healing period.

Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes.

Laparoscopic distal gastrectomy is an accepted option for gastric cancer surgery; however, laparoscopic total gastrectomy (LTG) is not widely performed. There is concern about the safety of the operation due to the difficulty of extracorporeal reconstruction through a mini-laparotomy. Efforts have been made to establish an intracorporeal anastomotic technique for esophagojejunostomy. This article reviews the current techniques available for laparoscopic esophagojejunostomy and their surgical outcomes. Several different techniques using either circular or linear staplers have been reported; however, the apparent superiority of any particular method has not been confirmed. The incidence of anastomosis-related complications varied among studies, but different techniques all successfully achieved excellent outcomes. The overall complication rate of LTG was similar to that of open total gastrectomy, suggesting that LTG is a safe and feasible option. However, the feasibility of LTG with D2 lymph node dissection for advanced upper gastric cancer needs to be confirmed in further studies, because most of the patients included in the LTG studies were diagnosed with early stages of disease.

Comparison of Intracorporeal Reconstruction after Laparoscopic Distal Gastrectomy with Extracorporeal Reconstruction in the View of Learning Curve

PurposeThe intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure.Materials and MethodsFrom January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases.ResultsIntracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group.ConclusionsIntracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.

Urethrale Anastomose bei orthotopem Blasenersatz nach roboterassistierter radikaler Zystektomie (RARC) an deutschsprachigen Robotikzentren

Following robot-assisted radical cystectomy (RARC) and extracorporeal reconstruction, robotic continuous suture techniques and those using open or robotically pre-positioned single sutures are used for the urethroneovesical anastomosis. 62 German-speaking robotic centres were asked in an online questionnaire whether they carried out RARC. Following an affirmative answer further questions were put to the form of the neobladder and the technique of the urethrovesical anastomosis. 80% of the online questionnaires were answered. 44% (n=22) of these centres perform the RARC. According to the answers, given all of the centres but one perform an extracorporeal construction of the neobladder [Studer bladder 73% (n=16), Hautmann bladder 18% (n=4), others 9% (n=2)]. After reconstruction 36% (n=8) of the teams perform a completely open surgical anastomosis with pre-positioned sutures, 24% (n=5) close the anastomosis in a single knot technique using robotically pre-positioned sutures and 40% (n=9) use continuous sutures during the intracorporeal reconstruction or after re-docking the robot. According to this questionnaire to German-speaking centres the most common anastomotic technique following extracorporeal reconstruction, mostly a Studer bladder, is that of the pre-positioned single knot sutures. This offers the advantage that a re-docking of the robotic cart is unnecessary. In contrast, however, to robotically performed suturing, there must be enough space in the open procedure to surgically tie-off the sutures of the anastomosis.

The Crooked Nose: Principles of Treatment

Correction of the crooked nose is one of the most challenging procedures in rhinoplasty. The goals of the surgery are creation of a rigid and straight cartilaginous L-strut, correction of the deviated bony structures, and improvement of the nasal airway. Curvatures of the dorsal septum can be corrected with several techniques. Spreader grafts, cartilage batten grafts, or ethmoid bone grafts can be utilized for internal stenting to straighten the dorsal deviations. The surgical treatment for a deformed caudal septum with the most predictable and successful outcome is resection and replacement with a straight septal cartilage graft. In severe deviations of septum cartilage involving both dorsal and caudal portions of the L-strut, extracorporeal reconstruction of the septal cartilage may be the required method. For correction of the deviated bony pyramid, several osteotomy methods can be employed. Medial osteotomy, low-to-low or low-to -high internal lateral osteotomy, double-level lateral osteotomies, and external lateral osteotomy are the options, depending on the deformity. Dorsal onlay grafts can provide camouflage for any residual asymmetries after septal reconstruction or can be applied for dorsal augmentation.

Laparoscopic Excision of Choledochal Cysts with Total Intracorporeal Reconstruction

There are numerous published reports of laparoscopic resection of choledochal cysts (CDCs), but almost all involve extracorporeal reconstruction of a biliary drainage system. We describe and evaluate the technique of laparoscopic CDC resection with total intracorporeal reconstruction. We reviewed all patients who underwent a laparoscopic CDC resection from March 2005 to January 2010 at Rocky Mountain Children's Hospital and Children's Hospital of New York-Presbyterian. We obtained data on operative time, characteristics of reconstruction, time to initiation of diet, length of stay, complications, and outcome. Thirteen patients (median age 5 years, range 1-16) underwent a laparoscopic CDC excision with total intracorporeal reconstruction. Four ports were used in all cases and no patients required conversion to an open procedure. Operative time ranged from 130 to 325 minutes (median 240 minutes). Median time to initiation of diet was 1 day (range 1-4 days). Median length of stay was 5 days (range 4-8 days). There were no cases of cholangitis; however, 1 patient developed a small bowel obstruction requiring re-operation. Laparoscopic resection of CDCs with total intracorporeal reconstruction is a safe and effective technique. The minimal handling of the bowel appears to minimize postoperative ileus, allows for early postoperative feeding and discharge.

939 DIVERSION RELATED COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010939 DIVERSION RELATED COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY Ricardo Brandina, Andre Berger, Alvaro Bosco, Monish Aron, Mihir Desai, Inderbir S. Gill, and Steven Campbell Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Alvaro BoscoAlvaro Bosco Cleveland, OH More articles by this author , Monish AronMonish Aron Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir S. GillInderbir S. Gill Los Angeles, CA More articles by this author , and Steven CampbellSteven Campbell Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open radical cystectomy (ORC) is the gold standard treatment for muscle-invasive bladder cancer. Laparoscopic radical cystectomy (LRC) with extracorporeal reconstruction is a minimally invasive alternative for the management of this disease. However, relatively short ureteral length and body habitus may make the diversion more challenging and could theoretically predispose to ureteral strictures and other diversion related complications. Herein we compare diversion related complications in patients who underwent ORC and LRC. METHODS A retrospective review was undertaken of 151 patients managed with either LRC (extracorporeal diversion) or ORC performed between August 2005 and November 2008. Diversion related and other clinical parameters were obtained from patient charts and review of the Social Security Death Index. RESULTS There were no significant differences between the LRC (n=64) and ORC (n=87) group with respect to mean patient age (70 vs. 69; p =0.7), BMI (28 vs. 28; p= 0.9), sex, ASA class, and operative indications. The ORC group had a higher prevalence of CKD and smoking history. The distribution of urinary diversions was similar between LCR (46 ileal conduit, 12 orthothopic neobladder, 6 continent cutaneous) and ORC groups (66 ileal conduit, 13 orthotopic neobladder, 8 continent cutaneous). The pathological findings were organ confined tumor (≤pT2 or less) or non-organ confined tumor (pT3-4) in 67% and 33% of the LCR cases and 58% and 42% of the ORC cases, respectively (p=0.25). The number of nodes retrieved was higher in ORC group (24 vs. 17, p=0.03). There were no differences between overall intraoperative complications (3% vs. 3%) and postoperative minor (21% vs. 31%, p=0.21) and major complications (8% vs. 7%, p=0.8). Seventeen diversion related complications were identified including: LRC (n = 9, 14%) with 7 ureteral stenosis, 1 total incontinence after neobladder requiring AUS, 1 urinary fistula requiring percutaneous bilateral nephrostomy tubes; ORC (n =8, 9.1%) with 6 ureteral stenosis, 1 neobladder disruption and 1 enteroureteral fistula. CONCLUSIONS Diversion related complications were marginally increased with LRC compared to ORC, although these evaluations did not reach statistical significance. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e366 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Brandina Los Angeles, CA More articles by this author Andre Berger Los Angeles, CA More articles by this author Alvaro Bosco Cleveland, OH More articles by this author Monish Aron Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir S. Gill Los Angeles, CA More articles by this author Steven Campbell Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Cistoprostatectomía radical robótica: análisis oncológico y funcional

IntroductionThe da Vinci robotic laparoscopic surgery, has been shown in radical prostatectomy, optimal functional and oncological results with a lower learning curve, greater comfort and vision for the surgeon, and proper preservation of the neurovascular bundles. This has led to begin the experience with robotic radical cystectomy (RRC). ObjectivesReview our initial experience in CRR, evaluating surgical and functional results obtained, and also immediate and short-term complications. Material and methodsBetween December 2007 and January 2009 we performed nine robotic radical cystoprostatectomy and in seven patients robotic lymphadenectomy (LDN). Five patients had a muscle-invasive disease and 4 non-muscle invasive bladder cancer. The median age was 57 years (range 34-81). Urinary diversion was performed extracorporeally in all cases, 3 cases an ileal conduit and 6 an Studer neobladder in 3 of these 6 cases, the urethra-neobladder anastomosis was performed intracorporeally. ResultsThe average time of surgery was 300 minutes (range 280-420) in the ileal conduit and 360 (range 330-540) in the Studer. No cases required conversion or blood transfusion. The median number of nodes removed by LDN robotics was 10 (range 6-18). The pathology revealed 3 pT0, 2 CIS, 3 pT3, 1 pT4b (positive margins). With a median follow up of 7 months there have been no peritoneal implant and only one ureteral stenosis. Oral diet was initiated in 5 cases at 48 hours. Of the 6 patients with preserved sexual function preoperatively and followup of more than 3 months, 2 had full erection at 1 month, 2 at 3 and 6 months, and the remaining 2 presented with a full erection with 5 PD inhibitors at 3 and 9 months. All patients with neobladder presented correct daytime continence. The average hospital stay was 8.5 days (range 7-19). ConclusionsThe radical robotic cystectomy with extracorporeal reconstruction of the urinary diversion offers good early functional and surgical outcomes. The careful preservation of the neurovascular bundles in radical pelvic surgery provides excellent results in urinary and sexual function.