Stapleless laparoscopic assisted radical cystectomy with ileal neobladder in a male and with ileal loop in a female: initial report from Brazil

Abstract

Introduction: Here, we report our initial experience with laparoscopic assisted radical cystectomy without the use of surgical staples.Cases Report: A 70 year old male and a 55 year old female were diagnosed to have T2G3 transitional cell carcinoma of the bladder with negative metastatic work-out. Both patients were scheduled and agreed to a laparoscopic assisted radical cystectomy. In both cases, urinary diversion (orthotopic ileal Studer neobladder in the male and ileal conduit in the female) was performed extracorporeally following radical cystectomy. In both cases control of the bladder vascular pediclewas accomplished with a combination of metallic and hem-o-lock clips. The total surgical time was 6.5 hours in both cases. Estimated intra-operative blood loss was 500 cc and 350 cc respectively, however both patients required postoperative blood transfusions. No intraoperative complications occurred. In both cases, pathology revealed negative surgical margins.Conclusions: Extracorporeal creation of urinary diversion decrease the overall operative time. Laparoscopic pelvic lymphadenectomy can be performed following the extended template. The use of surgical clips instead of vascular Endo-GIA titanium staples to control the bladder vascular pedicles is feasible and safe in selected patients, thus reducing intraoperative surgical costs. Considerable experience with laparoscopic radical prostatectomy is necessary before one attempts laparoscopic radical cystectomy.

Complications in laparoscopic radical cystectomy: The South American experience with 59 cases

“…Out of 7 intraoperative complications that occurred, 4 of them happened during control of the vascular pedicles. This may be related to the fact that we have mainly used clips (metallic or Hem-o-lock) or harmonic shears to control the vesical vascular pedicles in our cases, attempting to decrease the intraoperative costs related to the use of disposables such as the Endo-GIA stapler (up to 10 vascular loads could be used in one operation), which represents a great obstacle for laparoscopic radical cystectomy to gain acceptance, specially in developing countries (3,13). In one case, despite an uneventful operation, the patient developed chylous fistula (drain fluid analysis with a high concentration of triglycerides 1015 ng/dL and cholesterol 238 ng/dL).…”

“…All patients had negative metastatic work-out based on chest x-ray and abdominal computed tomography (CT). A 5-port transperitoneal approach was employed in all operations as described in details elsewhere (3,4). Nonetheless, more recently, in all institutions involved in this study, the camera port has been re-positioned 2 fingerbreadths above the umbilicus, thus facilitating the complete resection of the uracus.…”

The Dosimetric and Radiobiological Assessment of Three Intensity-Modulated Radiotherapy Techniques for The Treatment of Oropharyngeal Cancer

“…In our study no patient needed re-operation. The suction drain was removed on postoperative day 4 when the patient was discharged home [31]. In our results time to drainage tube removal was 10 (6 -14) days.…”

Cistectomia radical laparoscópica com reservatório ileal

“…A primeira cistectomia laparoscópica foi descrita em 1992 e desde então a experiência em todo o mundo tem crescido 4 , com diversas variações técnicas tendo sido publicadas nos últimos anos [1][2][3][4][5] . No Brasil, os primeiros casos foram descritos em 2005, utilizando a técnica vídeoassistida 3 .…”

“…Com a maior aceitação da cirurgia laparoscópica para o tratamento das doenças do trato urinário superior, recentemente tem havido um maior interesse na cirurgia laparoscópica pélvica. Nos últimos anos, a cistectomia radical laparoscópica tem sido relatada com sucesso e segurança em centros de excelência em Urologia [2][3][4][5] , com as vantagens de apresentar menor perda sangüínea, redução da dor pós-operatória, retorno precoce às atividades habituais e ao trabalho, e melhor resultado estético quando comparada à cirurgia aberta 1,2,5 . No entanto, fatores como maior tempo cirúrgico, aumento dos custos e ausência de dados referentes ao resultado oncológico a longo prazo representam algumas das desvantagens dessa via de acesso minimamente invasiva 3 .…”