Laparoendoscopic Single-site Radical Cystectomy Research Articles

Two-port laparoscopic radical cystectomy with reusable umbilical system: a feasibility study.

To describe the technique and report outcomes of laparoscopic radical cystectomy using 2 ports (2-port LRC) for muscle-invasive bladder cancer. Prospective study was performed between November 2011 and October 2012 to standardize 2-port LRC, lymph node dissection, and urinary diversion. Twenty patients were intervened (8 ileal conduit, 12 neobladder) and followed up for >1 yr. Median follow-up was 75.5 weeks (interquartile range, 65.2-86 weeks). A reusable system placed through the umbilicus and laparoscopic curved instruments with double rotation, plus one 10-mm extra port placed in the right iliac fossa were used. Neobladder or conduit was performed extracorporeally. Preoperative, perioperative, and pathologic outcomes and long-term security data are presented. Median age was 69.5 years; body mass index, 27.4 kg/m(2); operative time, 335 minutes; estimated blood loss, 337 mL; hospital stay, 9 days; intraoperative transfusion rate, 10%; and visual analog pain score, 3 at day 3. Surgical margin was positive in a case (5%); 3 (15%) were pT0, 2 (10%) pT1, 5 (25%) pT2, 6 (30%) pT3a, 3 (15%) pT3b, and 1 (5%) pT4. The number of nodes removed was 18.5 (interquartile range, 16-29.2), 4 (20%) positive. Complications were major in 2 (10%; fecal peritonitis and urinary sepsis) and minor in 4 (20%; ileus and 3 postoperative transfusion) cases. No case required additional analgesia. Incision was totally hidden in the umbilicus. Continence rate in neobladders was 91.7% at daytime and 75% at nighttime. Study limitation was the absence of a comparative cohort. Umbilical 2-port LRC is feasible with good oncologic and functional outcomes, low postoperative pain, and absence of abdominal wall complications. Difficulties have slowed laparoendoscopic single-site radical cystectomy, but umbilical 2-port LRC is a very acceptable alternative for minimally invasive surgery of muscle-invasive bladder cancer.

Laparo-endoscopic single-site radical cystectomy with orthotopic urinary diversion: Technique, feasibility, and the 3-year follow-up

ObjectivesTo assess the feasibility, operative morbidity and oncological outcome of laparoendoscopic single-site (LESS) radical cystectomy. Patients and methodsTen patients with clinical stage T1–T2 bladder cancer underwent a LESS radical cystectomy. The mean (SD) age of the patients was 64.8 (8.6)years and their mean body mass index was 25.9 (2.7)kg/m2. The procedure was done via a single-incision laparoscopic surgery port using a rigid 5-mm 30° long-shaft laparoscope in addition to the two working instruments. A 7-cm Pfannenstiel incision was made to remove the specimens and to allow the creation of an ileal neobladder with hand assistance. ResultsIn eight patients the LESS radical cystectomy was completed as scheduled, with the other two requiring a conversion, one to an open procedure due to locally advanced disease, and the other to conventional laparoscopy due to gas leakage. The mean (SD) operative duration was 236 (49)min, with a mean estimated blood loss of 575 (113)mL, and a mean hospital stay of 5.5 (0.7)days. No postoperative analgesic medications were prescribed and patients returned to normal activity after a mean (SD) of 17.6 (2.6)days. The pathological examination showed negative surgical margins for the bladder specimens, with a mean (SD) of 14 (1.9) lymph nodes retrieved. Seven patients were cancer-free within a mean (SD, range) follow-up of 37 (6, 29–44)months. ConclusionsLESS radical cystectomy is technically feasible, with a favourable course and convalescence, and it has an acceptable oncological outcome.

1030 Pilot feasibility study of umbilical laparoendoscopic single-site radical cystectomy for muscle-invasive bladder cancer with additional 10 mm trocar and extracorporeal urinary diversion

1030 Pilot feasibility study of umbilical laparoendoscopic single-site radical cystectomy for muscle-invasive bladder cancer with additional 10 mm trocar and extracorporeal urinary diversion

Laparoendoscopic single-site radical cystectomy and urinary diversion: initial experience using homemade single-port device

Objective We report our initial experience with laparoendoscopic single-site surgery (LESS) for radical cystectomy and urinary diversion performed by a single surgeon using homemade singleport device.Methods From December 2010 and April 2011,7 LESS radical cystectomy were performed using a home-made single-port device composed of an inverted cone device of polycarbonate and a powderfree surgical glove.7 patients were all male,mean age was 66 (54-81) years and mean BMI (Body mass index) was 23.1 (20.9-25.3) kg/m2.The port was placed into a 5 cm periumbilical skin incision.The conventional laparoscope and laparoscopic instruments were inserted through the single-port.No additional ports were needed for radical cystectomy and bilateral standard pelvic lymphadenectomy.Cutaneous ureterostomy (3 cases) and ileal conduit urinary diversion (4 cases) were used for patients.Operative time,estimated blood loss,postoperative recovering time,oncologic data and complications were collected and analyzed.Results All the procedures were completed successfully.The mean operative time was 210.1 (155-280) minutes.The estimated blood loss was 300 (100-500) ml.The bowel recovering time 8 (4-12) days and postoperative hospital stay was 20 (13-34) days.One patient required a transfusion of 400 ml red blood cells.The pathologic evaluation revealed that there were one case of pT1N0M0,two of pT2aN0M0,two of pT2bN0M0 and two of pT3aN0M0.The high grade tumor in 4 cases and low grade in 3 cases.The surgical margins were negative in all the patients.All patients were node negative.After the operations,one case had a small bowel obstruction after three days and was treated by abrosia,fluid infusion and gastrointestinal decompression.Another patient died of cardiac disease at first day postoperative.Conclusions In our experience,LESS for radical cystectomy could be clinically feasible for selected patients,but it requires the learning curve. Key words: Laparoscopy; Surgical instruments; Gloves, surgical; Cystectomy

Single-port laparoscopic cystectomy and intracorporeal urinary diversion assisted by transurethral access: preliminary study

Objective To make attempt for"no scar"cystectomy by pure LESS(laparoendoscopic single-site)surgery and transurethral NOTES(natural orifice transluminal endoscopic surgery)in pigs,so as to assess the feasibility and summarize the experience.Methods Female pigs weighing 30kg were given general anesthesia.A 2cm incision was made through the right lateral border of the rectus muscle,and the subcutaneous tissues and muscle layer were dissected bluntly with the Kelly clamp.The SILS port was introduced into the peritoneal cavity and the pneumoperitoneum was established.The bladder was dissected by the flexible forceps and scalpel.And the ureters and urethra were divided.Under the guidance of ureteroscopy,a 12mm trocar was introduced into the urethra.Through the transurethral access,the small intestine was divided by two Endo GIAs.The lateral-lateral anastomosis of intestine and the left side of ureter-intestinal anastomosis were performed with assistance of the transurethral access.After the specimens were retracted,the urethra was closed by 2-0suture.After the SILS port was removed,the right ureter and the small intestine for the stoma were pulled out of the peritoneal cavity.The right side of ureter-intestinal anastomosis was done outside of the body.Then the stoma was performed.Results Three cases were performed in a mean of(275±63)min(ranging from 210-335min)without additional trocars.Except for the stoma,there were no other incisions on the surface of the abdominal wall.Conclusion This "no scar"LESS radical cystectomy can be performed successfully with assistance of the transurethral access in pigs,but the operation is technically difficult.

Laparoendoscopic Single-Site Radical Cystectomy and Urinary Diversion: Initial Experience in China Using a Homemade Single-Port Device

We report our initial experience with the first series of laparoendoscopic single-site (LESS) radical cystectomy and urinary diversion performed by a single surgeon using a homemade single-port device at a single institution in China. Between December 2010 and February 2011, we performed five LESS radical cystectomis using a homemade single-port device composed of an inverted cone device of polycarbonate and a powder-free surgical glove. The port was placed into a 5-cm periumbilical incision. The conventional laparoscope and laparoscopic instruments were inserted through the single-port. No additional ports were needed for radical cystoprostatectomy and bilateral standard pelvic lymphadenectomy. Cutaneous ureterostomy and ileal conduit urinary diversion were used for our patients, respectively. Perioperatively, oncologic data and complications were collected and analyzed. All the procedures were completed successfully. The mean extirpative operative time was 208.2 (168-280) minutes, estimated blood loss was 270 (100-500) mL, bowel recovering time was 9.75 (6-12) days, and postoperative hospital stay was 19.5 (14-28) days. One patient needed a transfusion of 400 mL of red blood cells. The pathologic evaluation revealed negative margins and negative lymph node involvement. After the operations, one patient had a bowel obstruction, while another patient died from cardiac disease. Mean follow-up time was 143 (110-173) days. In our experience, LESS radical cystectomy is clinically feasible and safe for selected patients, but requires a learning curve. Our homemade single-port device is a cost-effective and convenient device. Although the initial outcomes have been promising, the long-term oncologic evaluation of these patients awaits.