Technique Of Laparoscopic Radical Cystectomy Research Articles

Лапароскопическая радикальная цистэктомия с поздним пересечением мочеточников

Despite considerable progress during last decade, laparoscopic radical cystectomy (LRC) still remains a complex and time-demanding procedure. The number of patients with baseline chronic kidney diseases has gradually increased. to compare the results of our novel technique of LRC with late dividing of the ureters with conventional procedure. A total of 50 patients with bladder cancer, who underwent to LRC in a single clinic between April 2013 and January 2017, were included in the study. A conventional LRC was performed in 25 patients, while in other 25 cases, a novel technique of LRC was used. In all cases, LRC was done with fully intracorporeal urinary diversion. Statistical analysis was performed using the Shapiro-Wilk test for parametric testing. In order to compare two groups, Student t-test was used for independent samples. There were no significant differences between two groups in average length of procedure, blood loss volume and length of hospital stay. Major intraoperative complications (injury of the rectum) occurred in two patients, one in each group. Both cases were successfully managed intraoperatively. In addition, there were two postoperative complications in each group that required repeat intervention. The mean serum creatinine level on the 2nd day after surgery was significantly higher after conventional LRC (171.6 and 147.7 mol/L), while glomerular filtration rate was significantly lower (58 and 72 ml/min/1.73 m2), compared to group of novel technique of LRC with late dividing of the ureters. A total of four patients in group of conventional LRC and two patients in group of novel technique had cancer progression. Two patients (one in each group) died because of cancer progression after 15 and 34 months after surgery. The mean follow-up was 25.6 (12-39) months after LRC with late dividing of the ureters and 33.2 (18-48) months in group of standard LRC. LRC with late dividing of the ureters allow to prevent prolonged contact of hyperosmolar and, in some cases, non-sterile urine with peritoneum and decrease inflammation and risk of postoperative adhesions. Using of novel technique may decrease rate of perioperative nephropathy, which is especially important in patients with decreased renal function (single functioning kidney, hydronephrosis, diabetes, renal failure, adjuvant chemotherapy). However, more procedures and longer follow-up period are necessary in order to evaluate ontological results of the novel technique.

Laparoscopic radical cystectomy with prostate capsule sparing. Initial experience.

IntroductionIn 2008, our department introduced a modified technique of laparoscopic radical cystectomy in which the prostatic capsule is spared in selected patients with bladder cancer. The different series published are mostly using the standard open procedure. The aim of this study is to describe this technique using the laparoscopic approach and present our preliminary results.Material and methodsThis study includes 20 patients selected by clinical analysis and imaging criteria operated using laparoscopic radical cystectomy with prostate capsule sparing at our department in the period between 2008 and 2012.ResultsPatient mean age was 58 years. Mean operative time was 390 minutes. Median follow-up was 36 months. No patient had bladder cancer recurrence. Only one patient died of disease progression, as the pathological findings was a pT3 pN1 Mx. Mean PSA before surgery: 1.3 ng/ml (03–2), mean PSA after surgery 1.0 ng/ml (0.08–1.7). No patients had prostate cancer recurrence. Satisfactory daytime and night-time continence was achieved. 90% of patients have sexual function preserved.ConclusionsProstate-sparing radical cystectomy remains one of the most controversial topics in urology today. The laparoscopic approach could be an alternative to conventional radical cystoprostatectomy in well selected patients, done in experienced institutions in order to find better functional results, with a low disease progression and recurrence rate.

An improved technique for bladder cancer: Pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder using titanium staples

ObjectiveTo report our experience with an improved technique of laparoscopic radical cystectomy (LRC) and orthotopic ileal neobladder reconstruction, evaluating the perioperative and pathological outcomes. MethodsWe retrospectively reviewed the data of 56 cases who underwent radical cystoprostatectomy followed by construction of an orthotopic U-shaped ileal neobladder between August 2010 and December 2014. These data include intraoperative data, early and long-term postoperative complications, neobladder function, urinary continence and oncologic results. Also the key innovative procedure was introduced with details. ResultsThe median time of the overall procedure was 212 min. The median estimated blood loss was 171 ml. The median hospitalization time after the operation was 21 days. Complications included two cases of unilateral ureter-pouch anastomotic strictures, one case of bilateral ureteral stricture, three cases of vesicourethral anastomotic strictures and three cases of vesicourethral leakage. The mean maximum pouch capacity was 446 ± 32 ml, and pouch pressure at capacity was 18.1 ± 2.6 cm H2O. The Qmax was 14 ± 1.2 ml/s, and the mean postvoid residual was 25 ± 10 ml. There were 9 cases of night-time incontinence at 3 months post-operatively. Negative surgical margins of the bladder specimens were achieved in all patients. During a follow-up period of 3–44 months (average 32.6 months), local recurrence was found in two patients and distant metastasis was occurred in another 3 patients. ConclusionsOur preliminary experience showed that pure LRC with nonabsorbable titanium staples assisted orthotopic U-shape ileal neobladder reconstruction is feasible based on perioperative data and oncologic features.

152 INVITED Innovations in radical cystectomy

We introduce the operative technique of laparoscopic radical cystectomy and orthotopic ileal neobladder with a Studer limb performed completely intracorporeally.The procedure was performed in 1 man and 1 woman. Using a 6 port transperitoneal approach, radical cystectomy in the female patient and radical cystoprostatectomy in the male patient were completed laparoscopically with the urethral sphincter preserved. Bilateral pelvic lymphadenectomy was done. A 65 cm. segment of ileum 15 cm. from the ileocecal junction was isolated, and ileo-ileal continuity was restored using Endo-GIA staplers (U.S. Surgical, Norwalk, Connecticut). The distal 45 cm. of the isolated ileal segment were detubularized, maintaining the proximal 10 cm. segment intact as an isoperistaltic Studer limb. A globular shaped ileal neobladder was constructed and anastomosed to the urethra. Bilateral stented ureteroileal anastomoses were individually performed to the Studer limb. All suturing was done exclusively using free-hand laparoscopic techniques and the entire procedure was completed intracorporeally. An additional case is described of Indiana pouch continent diversion in which the pouch was constructed extracorporeally.Total operative time for laparoscopic radical cystectomy and orthotopic neobladder was 8.5 and 10.5 hours, respectively, with a blood loss ranging from 200 to 400 cc. Hospital stay was 5 to 12 days and surgical margins of the bladder specimen were negative in each case. Both patients with orthotopic neobladder had complete daytime continence. Postoperative renal function was normal and excretory urography revealed unobstructed upper tracts. During followup ranging from 5 to 19 months 1 patient died of metastatic disease, while the other 2 are doing well without local or systematic progression.Laproscopic radical cystectomy and orthotopic ileal neobladder performed completely intracorporeally are feasible.

Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorporeally: the initial experience. : J Urol 2002;168:13–18.

Purpose: We introduce the operative technique of laparoscopic radical cystectomy and orthotopic ileal neobladder with a Studer limb performed completely intracorporeally. Materials and Methods: The procedure was performed in one man and one woman. Using a 6-port transperitoneal approach, radical cystectomy in the female patient and radical cystoprostatectomy in the male patient were completed laparoscopically with the urethral sphincter preserved. Bilateral pelvic lymphadenectomy was done. A 65-cm segment of ileum 15 cm from the ileocecal junction was isolated, and ileo-ileal continuity was restored using Endo-GIA staplers (U.S. Surgical, Norwalk, Connecticut). The distal 45 cm of the isolated ileal segment were detubularized, maintaining the proximal 10-cm segment intact as an isoperistaltic Studer limb. A globular shaped ileal neobladder was constructed and anastomosed to the urethra. Bilateral stented ureteroileal anastomoses were individually performed to the Studer limb. All suturing was done exclusively using free-hand laparoscopic techniques and the entire procedure was completed intracorporeally. An additional case is described of Indiana pouch continent diversion in which the pouch was constructed extracorporeally. Results: Total operative time for laparoscopic radical cystectomy and orthotopic neobladder was 8.5 and 10.5 hs, respectively, with a blood loss ranging from 200 to 400 cc. Hospital stay was 5 to 12 days and surgical margins of the bladder specimen were negative in each case. Both patients with orthotopic neobladder had complete daytime continence. Postoperative renal function was normal and excretory urography revealed unobstructed upper tracts. During followup ranging from 5 to 19 months one patient died of metastatic disease, whereas the other two are doing well without local or systematic progression. Conclusions: Laparoscopic radical cystectomy and orthotopic ileal neobladder performed completely intracorporeally are feasible.

Laparoscopic radical cystectomy with orthotopic neobladder.

We report our technique of laparoscopic radical cystectomy in nine patients. Diversion was achieved by a modified Camey II orthotopic neobladder (the Y bladder) performed by a minilaparotomy in three cases and laparoscopically in the last six cases. There were eight men with muscle-invasive transitional-cell carcinoma and one woman with verrucous squamous-cell carcinoma of the bladder. The age range was 41 to 65 years. The control of the posterior and lateral bladder pedicles was achieved by vascular Endo-GIA in the first three cases and by the 10-mm Harmonic Shears (Ultracision; Ethicon) in the last six cases. The operative specimen was extracted through a 3- to 5-cm muscle-splitting incision in the right iliac fossa. The detubularized pouch was prepared extracorporeally through the same incision. The urethral and ureteral anastomoses were performed using laparoscopic intracorporeal suturing in the last six cases. The operative time ranged from 6.5 to 12 hours (median 8.3 hours). The blood loss was 150 to 500 mL. Oral feeding was resumed on the 3rd postoperative day. The stents were usually removed on the 8th postoperative day. A pouchogram was obtained on the 10th postoperative day, and the urethral catheter was removed. The lymph nodes as well as the surgical margins were tumor free. Laparoscopic radical cystectomy and orthotopic neobladder creation is feasible, although difficult and technically demanding. The use of the Harmonic Shears in the cystectomy reduces the operative cost significantly. With growing experience, laparoscopic radical cystectomy and continent urinary diversion can be an alternative to the open technique.

Laparoscopic Radical Cystectomy and Continent Orthotopic Ileal Neobladder Performed Completely Intracorporeally: The Initial Experience

We introduce the operative technique of laparoscopic radical cystectomy and orthotopic ileal neobladder with a Studer limb performed completely intracorporeally. The procedure was performed in 1 man and 1 woman. Using a 6 port transperitoneal approach, radical cystectomy in the female patient and radical cystoprostatectomy in the male patient were completed laparoscopically with the urethral sphincter preserved. Bilateral pelvic lymphadenectomy was done. A 65 cm. segment of ileum 15 cm. from the ileocecal junction was isolated, and ileo-ileal continuity was restored using Endo-GIA staplers (U.S. Surgical, Norwalk, Connecticut). The distal 45 cm. of the isolated ileal segment were detubularized, maintaining the proximal 10 cm. segment intact as an isoperistaltic Studer limb. A globular shaped ileal neobladder was constructed and anastomosed to the urethra. Bilateral stented ureteroileal anastomoses were individually performed to the Studer limb. All suturing was done exclusively using free-hand laparoscopic techniques and the entire procedure was completed intracorporeally. An additional case is described of Indiana pouch continent diversion in which the pouch was constructed extracorporeally. Total operative time for laparoscopic radical cystectomy and orthotopic neobladder was 8.5 and 10.5 hours, respectively, with a blood loss ranging from 200 to 400 cc. Hospital stay was 5 to 12 days and surgical margins of the bladder specimen were negative in each case. Both patients with orthotopic neobladder had complete daytime continence. Postoperative renal function was normal and excretory urography revealed unobstructed upper tracts. During followup ranging from 5 to 19 months 1 patient died of metastatic disease, while the other 2 are doing well without local or systematic progression. Laproscopic radical cystectomy and orthotopic ileal neobladder performed completely intracorporeally are feasible.