Laparoscopic Radical Cystoprostatectomy Research Articles

Review of the article “Laparoscopic extraperitoneal radical cystoprostatectomy: for whom and how?”

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Extensive penile glans and corpus spongiosum necrosis due to catheter traction following laparoscopic radical cystoprostatectomy: a rare case report and literature review

BackgroundPenile glans and corpus spongiosum necrosis is an extremely rare urologic condition associated with substantial morbidity.Case presentationWe report a rare case presenting extensive penile glans and corpus spongiosum necrosis following catheter traction in a 71-year-old male patient who had a laparoscopic radical cystoprostatectomy for muscle-invasive bladder cancer. The patient has no preexisting diabetes mellitus or chronic renal failure. The case was successfully managed with penile preservation. During the procedure, it was observed that the necrosis was not limited to the glans. The necrosis had spread to the entire penile urethra and corpus spongiosum, and an excision of approximately 14 cm of corpus spongiosum was performed.ConclusionThis is the first case presenting extensive length of penile glans and corpus spongiosum necrosis managed successfully with penile preservation, enabling reaching the best functional and esthetic results reported in the literature. Early detection and urgent imaging with a high index of suspicion ensure a favorable outcome. The main treatment steps are careful evaluation, appropriate therapy, and prompt intervention depending on the severity.

Nerve-Sparing Laparoscopic Cystoprostatectomy Based on Inferior Hypogastric Plexus Dissection: Our Initial Experience

Introduction: The aim of this study was to implement our technique for the initial dissection of the inferior hypogastric plexus and protection of the autonomic nerve supply to the corpora cavernosa in laparoscopic radical cystoprostatectomy with an orthotopic ileal neobladder and report the initial outcomes. Methods: Eleven normally potent patients with preoperative cT2N0 bladder cancer who underwent bilateral nerve-sparing laparoscopic cystoprostatectomy performed by the same surgeon were selected from May 2018 to September 2020. In this procedure, the anterior part of the inferior hypogastric plexus was dissected first between the prehypogastric nerve fascia and rectal proper fascia medial to the distal ureter. Then the Denonvilliers’ fascia and the nerves around the prostate were preserved according to current intrafascial principles. The preliminary operative, oncologic, and functional results are presented. Results: The median follow-up duration was 18 months. We observed early and late complications in 5 patients, but none exceeded grade III. Of the 11 patients, ten gained daytime continence (90.9%), and 8 (72.7%) showed nocturnal continence at the last follow-up. Regarding postoperative potency, 10 of the 11 patients (90.9%) remained potent with or without oral medications, excluding one who had partial tumescence but did not follow our recommendations regarding medication use. No local recurrence or positive surgical margins were noted. Conclusion: In addition to emphasizing our cavernosal nerve-sparing procedure, this report on the precise dissection and protection of the inferior hypogastric plexus could be of clinical significance, providing potentially ideal short-term functional results.

Tips and Tricks for Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Pelvic Lymph Node Dissection

Introduction: Radical cystoprostatectomy and bilateral pelvic lymph node dissection remain the standard therapy for muscle-invasive urothelial carcinoma of the bladder. A minimally invasive robotic approach to the extirpative portion of radical cystectomy has become increasingly prevalent. We sought to develop a step-by-step video to share the lessons learned in our initial series of robotic cystectomy cases. Materials and Methods: Eighty-one patients underwent robot-assisted laparoscopic radical cystectomy by a single surgeon from March 2011 to June 2017. Patient demographics, pathologic analysis, and outcomes were obtained. Surgical Technique: We begin with a posterior dissection developing a plane between the rectum and prostate. We then proceed with a unilateral approach taking the lymph nodes and pedicles on one side, then replicate a similar procedure on the contralateral side. The left ureter is passed under the mesocolon and the presacral nodes are removed. We then complete the cystoprostatectomy with anterior dissection of the prostate apex. Although urinary diversion was not demonstrated in this video, extracorporeal urinary diversion was completed for ileal conduits and continent diversions, whereas a hybrid approach was performed for ileal neobladders. Results: The mean age at surgery was 70 years (range 51–89) and 76% were men. Thirty-eight percent underwent neoadjuvant chemotherapy, and 62% ileal conduit, 32% ileal neobladder, and 5% continent urinary diversions were created. Overall 90 day Clavien I-II complication rates were 27% and Clavien III-V complication rates were 11%. Final pathology report included T0-T2 (40%), T2 (14%), and T3-T4 (46%), and 31% were positive lymph nodes. There was one positive surgical margin and mean lymph node counts were 29 (range 3–87). Overall survival was 74% with a mean follow-up of 44 months (range 1–78). Conclusions: Robot-assisted laparoscopic radical cystoprostatectomy and extended pelvic lymph node dissection can be performed safely with favorable pathologic outcomes in surrogates of surgical margins and a number of lymph nodes were removed. Long-term outcomes will need to mature. With increasing experience, our results have suggested that this procedure can be performed expeditiously without sacrificing pathologic and clinical outcomes. No competing financial interests exist. The authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure. Runtime of video: 10 mins

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.

Evaluation of Open and Laparoscopic Radical Cystoprostatectomy Combined with Orthotopic Neobladder: A Single-Surgeon Experience

Aim: To compare the outcomes of laparoscopic (LRCP) and open radical cystoprostatectomy (ORCP) with orthotopic urinary diversion for muscle-invasive organ-confined bladder cancer by a single surgeon. Patients and Methods: Prospectively documented 15 LRCP and 15 ORCP patients, followed for at least 3 years, were included in our study. The demographic parameters of patients, preoperative radiologic staging, previous operations, surgical outcomes, complications, oncologic results and intermediate-term follow-up, postoperative chemotherapy and follow-up periods were recorded and evaluated. Results: The mean oncologic follow-up was 3 years. Transfusion rate, estimated blood loss, oral intake and narcotic analgesic requirement were statistically less in the LRCP group (p < 0.05). However, operation time and hospital stay were similar in both groups. The complication rates were not significantly different between the two groups. The mean number of dissected lymph nodes was 20.0 ± 1.7 in the ORCP and 22.6 ± 2.0 in the LRCP group. One patient in each group had a margin positive for bladder cancer. Conclusions: The laparoscopic approach may be feasible for muscle-invasive organ-confined bladder cancer. Furthermore, LRCP provides less blood loss, early oral intake and postoperative pain management. Additionally, continence and sexual function may be provided by LRCP as with ORCP.

Perioperative Outcomes and Oncologic Efficacy from a Pilot Prospective Randomized Clinical Trial of Open Versus Robotic Assisted Radical Cystectomy

Robotic assisted laparoscopic radical cystectomy for bladder cancer has been reported with potential for improvement in perioperative morbidity compared to the open approach. However, most studies are retrospective with significant selection bias. A pilot prospective randomized trial evaluating perioperative outcomes and oncologic efficacy of open vs robotic assisted laparoscopic radical cystectomy for consecutive patients was performed from July 2009 to June 2011. To date 47 patients have been randomized with data available on 40 patients for analysis. Each group was similar with regard to age, gender, race, body mass index and comorbidities, as well as previous surgeries, operative time, postoperative complications and final pathological stage. We observed no significant differences between oncologic outcomes of positive margins (5% each, p = 0.50) or number of lymph nodes removed for open radical cystectomy (23, IQR 15-28) vs robotic assisted laparoscopic radical cystectomy (11, IQR 8.75-21.5) groups (p = 0.135). The robotic assisted laparoscopic radical cystectomy group (400 ml, IQR 300-762.5) was noted to have decreased estimated blood loss compared to the open radical cystectomy group (800 ml, IQR 400-1,100) and trended toward a decreased rate of excessive length of stay (greater than 5 days) (65% vs 90%, p = 0.11) compared to the open radical cystectomy group. The robotic group also trended toward fewer transfusions (40% vs 50%, p = 0.26). Our study validates the concept of randomizing patients with bladder cancer undergoing radical cystectomy to an open or robotic approach. Our results suggest no significant differences in surrogates of oncologic efficacy. Robotic assisted laparoscopic radical cystectomy demonstrates potential benefits of decreased estimated blood loss and decreased hospital stay compared to open radical cystectomy. Our results need to be validated in a larger multicenter prospective randomized clinical trial.

Robot-Assisted Laparoscopic Bilateral Nerve-Sparing Radical Cystoprostatectomy for Bladder Cancer

Introduction: We present an 8-minute video of bilateral nerve-sparing (NS) robot-assisted laparoscopic radical cystoprostatectomy (RALC) performed for invasive bladder cancer. Materials and Methods: Between December 2009 and April 2010, we performed 12 NS-RALC procedures with intracorporeal Studer pouch formation and bilateral extended pelvic lymph node dissection for muscle invasive bladder cancer.1,2 Trocars: six ports were used (a 12-mm camera, three 8-mm robotic, 12- and 15-mm assistant ports). NS radical cystoprostatectomy: a zero-degree lens is used. Patient position: maximum trendelenburg (30°). Peritoneum overlying the ureters is incised. Ureters are dissected off until entering the bladder, clipped from their most distal part. Distal ends are sent for frozen analysis. Peritoneum overlying the anterior wall of the Douglas' pouch is incised; vasa and seminal vesicles (SV) are exposed. Fascial leaflet of Denonvilliers' fascia is opened over the SV and dissected off until membraneous urethra is reached. Neurovascular bundles (NVB) are dissected laterally from prostatic base to apex with blunt dissection on each side. Extensions from NVB at the level of the tips of SV is clipped with hem-o-lock and used as a landmark for the future part of NVB dissection. Peritoneum lateral to the medial umblical ligaments is incised; pubic bones are exposed. Endopelvic fascia is opened after removal of overlying fatty tissue. The levator ani muscle fibers are dissected off. Prostatic fascia is released bilaterally to make a high anterior release and NVB dissection continued. Ligation of the lateral bladder pedicle is accomplished with the use of Ligasure® starting from medial to external iliac artery until the hem-o-lock clip at the level of ipsilateral SV tip is reached. Distal to this level, NVB is dissected off of the SV wall and posterolateral prostate with sharp and blunt dissection and hem-o-lock clips when necessary. No energy is used around NVB. Transection of the urachus at the level of umblicus and attacments between anterior bladder wall with the abdomen completes bladder dissection. Puboprostatic ligaments are cut and dorsal venous complex is suture tied with 2/0-vicryl and severed with bipolar and monopolar scissors. Urethral catheter is withdrawn, and a 0/0-vicrly suture is passed across urethra at the level of prostatic apex. Free end of this suture is then passed underneath the urethra, and tied on the apex. Urethra is cut flush with the apex and specimen is placed in an endobag. A 12-mm rim from the most proximal urethral remnant is sent for frozen analysis. Results and Conclusions: Mean console time (whole procedure) was 10 hours (8.1–11.5); mean intraoperative blood loss was 455 mL (100–700); mean lymph node yield was 21.3 (8–38). Surgical margins were negative in all patients. Perioperative death rate was zero. Right external iliac vein injury occurred in one patient during performing lymph node dissection whom we converted to open surgery and repaired. RALC is a safe procedure and can be learned and performed with excellent short-term surgical results and satisfactory pathological outcomes. No competing financial interests exist. Presented during the 28th World Congress of Endourology and SWL, September 1–4, 2010, Chicago, IIlinois. Runtime of video: 8 mins

Robot-Assisted Laparoscopic Nerve-Sparing Radical Cystoprostatectomy with Bilateral Extended Lymph Node Dissection and Intracorporeal Studer Pouch Construction: Outcomes of First 12 Cases

We report our initial experience with robot-assisted laparoscopic neurovascular bundle (NVB) sparing radical cystoprostatectomy (RALRC), bilateral extended lymph node dissection (BELND) with intracorporeal Studer pouch construction for invasive bladder cancer. After initially performing >50 cases of robot-assisted laparoscopic radical prostatectomies (RALRP), between December 2009 and April 2010, we performed 12 RALRC procedures with BELND. Bilateral (n=10) and unilateral (n=1) intrafascial NVB preservation was performed in 11 patients; nonnerve-sparing RALRC was performed in 1 patient. Patient characteristics and surgical and postoperative parameters were mean patient age (y): 60 (43-80); American Society of Anesthesiologists score: 2 (1-3); body mass index (kg/m(2)): 24.5 (19.3-31.2); preoperative International Index of Erectile Function (IIEF) score: 25 (5-65); operative time (h): 10 (8.1-11.5); intraoperative blood loss (mL): 455 (100-700); lymph node (LN) yield: 21.3 (8-38); hospital stay (d): 10.7 (9-16); lodge drain removal (d): 10 (9-15). Five patients received neoadjuvant chemotherapy. Surgical margins were negative in all patients. Postoperative pathologic stages were: pT(0) (n=2), pT(1) (n=1), pT(2a) (n=2), pT(2b) (n=2), pT(3a) (n=4), and pT(4a) (n=1). Positive LNs and incidental prostate cancer were detected in five and three patients, respectively. Perioperative death rate was zero. Right external iliac vein injury occurred in one patient during the performance of BELND; surgery was converted to an open procedure and the injury was repaired. Colonic fistula developed in one patient at postoperative day 40; the patient died from cardiac disease at day 60. At a mean follow-up of 7.1 ± 2.3 months, three patients died from metastatic disease. Of the available seven patients, six were fully continent and one had mild daytime incontinence. Although RALRC with bilateral intrafascial NVB preservation, BELND, and intracorporeal Studer pouch formation is a complex procedure, it can be performed with excellent short-term surgical and pathological outcomes and satisfactory functional results after considerable experience gained with RALRP procedures.

Robot-assisted laparoscopic combined nephroureterectomy and cystoprostatectomy: an initial report and review of the literature.

Patients presenting with invasive, high-grade, or recurrent bladder cancer and synchronous upper urinary tract malignancy may be considered for simultaneous nephroureterectomy and radical cystectomy. We present the first known reported case of robot-assisted laparoscopic combined nephroureterectomy and cystoprostatectomy, describing a 62-year-old man with recurrent T1 bladder cancer and concomitant upper urinary tract transitional cell carcinoma. Patient underwent robot-assisted laparoscopic combined nephroureterectomy and radical cystoprostatectomy with extended pelvic lymph node dissection and extracorporeal ileal conduit urinary diversion. Robotic surgery was completed successfully without need for conversion to open procedure. There were no operative or perioperative complications. Blood loss (200ml) and hospital stay (7days) were less than prior reported laparoscopic experience with combined surgery. Although indications may be rare, robotic nephroureterectomy with simultaneous radical cystoprostatectomy is a feasible and safe surgical option.

Hybrid Laparoscopic Endoscopic Single-Site Surgery for Radical Cystoprostatectomy and Orthotopic Ileal Neobladder with a Homemade Mutichannel Port

Abstract Introduction: Laparoscopic radical cystoprostatectomy (LRC) has been demonstrated to be safe and feasible in selected centers. Recently, laparoscopic endoscopic single-site surgery (LESS) ...

An Unexpected Resident in the Ileum Detected During Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Studer Pouch Formation: Taenia Saginata Parasite

A case of moving ileal Taenia saginata parasites is presented with demonstrative images. We came across the parasites surprisingly while performing robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal Studer pouch urinary diversion. We recommend stool sample evaluation in the preoperative period for possible presence of intestinal parasitic diseases, particularly in patients with bladder cancer who are admitted from areas with an increased incidence of intestinal parasitic diseases, before opening the bowel segments during surgery to perform radical cystectomy and urinary diversion.

Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC)

AimThe aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomy in men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC).Material and methodsFifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radical cystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC group was composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymph nodes were removed separately, but were added and analysed together for each side. Nodes dissected from one side during ORC were compared to en bloc dissected nodes in the LRC group.ResultsThere were no complications associated with extended pelvic lymph node dissection during LRC or ORC. There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2 tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in the pT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentage of patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. The laparoscopic group with pT3 disease was too small to analyse.ConclusionsWe have found that laparoscopic radical cystectomy can be performed without any compromise in lymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resulted in sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume of lymph nodes.

Ureteric Duplication is not a Contraindication for Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Studer Pouch Formation

Ureteric duplication is a rarely seen malformation of the urinary tract more commonly seen in females. We report 2 cases of robot-assisted laparoscopic radical cystoprostatectomy (RALRCP) with bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch formation in patients with duplicated right ureters. Two male patients (53 and 68 years old) underwent transurethral resection of a bladder tumor that revealed high-grade muscle invasive transitional cell carcinoma, with no metastases. We performed RALRCP and intracorporeal Studer pouch formation. A duplicated right ureter was observed during the procedures in both patients. Left ureter distal segment was spatulated 2cm long and anastomosed using running 4/0 Vicryl to the right ureter at its bifurcation where it forms a single lumen without spatulation. All 3 ureters were catheterized individually. A Wallace type uretero-ileal anastomosis was performed between the ureters and the proximal part of the Studer pouch chimney. Although ureteric frozen section analysis suggested ureteric carcinoma in situ in patient 1, postoperative pathologic evaluation was normal. Frozen section and final postoperative pathologic evaluations were normal in patient 2. Duplicated ureters might be underdiagnosed on CT. The presence of a duplicated ureter is not a contraindication to RALRCP and intracorporeal Studer pouch formation. The da Vinci-S surgical robot is very safe for performing this complicated procedure. Frozen section analysis of ureters during radical cystectomy for bladder cancer might not reliably diagnose the pathologic condition and might overestimate the disease in the ureters.

Rapid Metastasis to the Scrotum and Penis following Laparoscopic Radical Cystoprostatectomy

We present a case of rapid metastasis to the scrotum and penis within 2 months following a laparoscopic radical cystoprostatectomy in a 61-year-old male. The aim of this case report is to highlight the potential risk of rapid metastasis to both urologist and urological oncologist in all patients undergoing a laparoscopic radical cystoprostatectomy.

Oncological Outcomes After Radical Cystectomy for Bladder Cancer: Open Versus Minimally Invasive Approaches

The number of centers performing robotic assisted radical cystectomy has recently increased, spurring greater concerns about oncological outcomes. In this review we summarize the most comprehensive articles published on the oncological outcomes of laparoscopic assisted, robotic assisted and open radical cystectomy. A MEDLINE/PubMed literature search was conducted in March 2009 to review English language articles published from 1998 onward. Of 217 selected articles on the 3 techniques 19 studies were selected for this review. The laparoscopic series reported recurrence-free survival rates in the range of 83% to 85% at 1 to 2 years and 60% to 77% at 2 to 3 years, while the robotic assisted studies reported recurrence-free survival rates of 86% to 91% at 1 to 2 years. Large open surgery studies showed 62% to 68% recurrence-free survival at 5 years and 50% to 60% at 10 years, with overall survival of 59% to 66% at 5 years and 37% to 43% at 10 years. Overall survival in the laparoscopic cohorts was 90% to 100% at 1 to 2 years and 50% to 87% at 2 to 3 years. Publications reporting robotic cases demonstrated a 90% to 96% overall survival in 1 to 2 years of followup. Despite the surge of centers adopting minimally invasive approaches for radical cystectomy, the long-term effectiveness of these techniques has not yet been proven. This review of recent and landmark articles on open and minimally invasive procedures emphasizes the need for prospective controlled studies and long-term followup data to determine the proper use of laparoscopic and robotic assisted techniques in bladder cancer surgery.

Cost Analysis of Robotic Versus Open Radical Cystectomy for Bladder Cancer

Recently robotic approaches to cystectomy have been reported, and while clinical and oncological efficacy continues to be evaluated, potential financial costs have not been clearly evaluated. In this study we present a financial analysis using current cost structures and clinical outcomes for robotic and open cystectomy for bladder cancer. The financial costs of robotic and open radical cystectomy were categorized into operating room and hospital components, and further divided into fixed and variable costs for each. Fixed operating room costs for open cases involved base cost as well as disposable equipment costs while robotic fixed costs included the amortized machine cost as well as equipment and maintenance. Variable operating room costs were directly related to length of surgery. Variable hospital costs were directly related to transfusion requirement and length of stay. The means of the prior 20 cases of robotic and open cystectomy were used to perform a comparative cost analysis. Mean fixed operating room costs for robotic cases were $1,634 higher than for open cases. Operating room variable costs were also higher by a difference of $570, directly related to increased operating room time. Hospital costs were nearly identical for the fixed component while variable costs were $564 higher for the open approach secondary to higher transfusion costs and longer mean length of stay. Based on these findings robotic cystectomy is associated with an overall higher financial cost of $1,640 (robotic $16,248 vs open $14,608). Cost calculators were constructed based on these fixed and variable costs for each surgical approach to demonstrate the expected total costs based on varying operating room time and length of stay. Robotic assisted laparoscopic radical cystectomy is associated with a higher financial cost (+$1,640) than the open approach in the perioperative setting. However, this analysis is limited by its single institution design and a multicenter followup study is required to provide a more comprehensive analysis.

Robotic salvage cystectomy in the nonagenarian.

Radical cystectomy with pelvic lymphadenectomy remains the standard treatment for muscle-invasive bladder cancer. However, bladder preservation with radiotherapy, with or without chemotherapy, represents an alternative treatment strategy. In patients that fail this bladder conservation treatment, salvage cystectomy is then indicated to treat persistent or recurrent cancer. We report our experience with robotic-assisted laparoscopic salvage radical cystoprostatectomy with pelvic lymph node dissection in a 91-year-old man. This minimally invasive approach for treatment of persistent bladder cancer refractory to chemoradiation, even in the nonagenarian, is a safe and viable alternative to traditional open surgery.

Radical Cystectomy for Bladder Cancer: Morbidity of Laparoscopic Versus Open Surgery

We compared the morbidity and mortality of laparoscopic vs open surgery in radical cystectomy for bladder cancer. This prospective, nonrandomized study was conducted between January 2003 and July 2007 in 68 patients (7 women and 61 men) who underwent radical cystectomy for bladder cancer. A total of 38 cystectomies were performed laparoscopically and 30 by open surgery. Mean patient age was 68.0 +/- 9.0 years. Median preoperative American Society of Anesthesiologists score was 2 (range 1 to 3) in both groups. Intraoperative blood loss and transfusion rate were significantly lower in the laparoscopic surgery group. Postoperatively the incidence of minor complications and mortality were also significantly lower. Postoperative opioid consumption was significantly less in the laparoscopic surgery group in amount and duration. Resumption of oral fluid and solid intake as well as return to normal bowel function were significantly more rapid in the laparoscopic surgery group, and mean hospital stay was significantly shorter. Mean patient followup was 30.5 +/- 17.2 months. Laparoscopic radical cystectomy for bladder cancer has a lower morbidity rate than cystectomy by open surgery. It allows more rapid resumption of oral fluid and solid intake as well as return to normal bowel function and shorter hospital stay.

Laparoscopic Repair of an Iliac Artery Injury During Radical Cystoprostatectomy

Laparoscopy has experienced significant growth in the last 5 years and became more popular among practicing urologists. Even though laparoscopy is considered a safe technique it is not free of complications, some of which can be devastating. Vascular injuries are the second most frequent complication during laparoscopic surgery with a reported incidence of 0.22% to 1.1%. With the standardization of surgical techniques and the increasing proficiency of the teams performing it, serious surgical complications may be corrected without the need for conversion. We report a case in which the right external iliac artery was injured while pelvic lymph node dissection was carried out before a planned laparoscopic radical cystoprostatectomy. The complication was successfully managed entirely by means of laparoscopy.