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

Abstract

Objective: In this study, we have gathered the second largest series yet published on laparoscopic radical cystectomy in order to evaluate the incidence and cause of intra and postoperative complication, conversion to open surgery, and patient mortality. Materials and Methods: From 1997 to 2005, 59 laparoscopic radical cystectomies were performed for the management of bladder cancer at 3 institutions in South America. Twenty nine patients received continent urinary diversion, including 25 orthotopic ileal neobladders and 4 Indiana pouches. Only one case of continent urinary diversion was performed completely intracorporeally. Results: Mean operative time was 337 minutes (150-600). Estimated intraoperative blood loss was 488 mL (50-1500) and 12 patients (20%) required blood transfusion. All 7 (12%) intraoperative complications were vascular in nature, that is, 1 epigastric vessel injury, 2 injuries to the iliac vessels (1 artery and 1 vein), and 4 bleedings that occurred during the bladder pedicles control. Eighteen (30%) postoperative complications (not counting mortalities) occurred, including 3 urinary tract infections, 1 pneumonia, 1 wound infection, 5 ileus, 2 persistent chylous drainage, 3 urinary fistulas, and 3 (5%) postoperative complications that required surgical intervention (2 hernias -one in the port site and one in the extraction incision, and 1 bowel obstruction). One case (1.7%) was electively converted to open surgery due to a larger tumor that precluded proper posterior dissection. Two mortalities (3.3%) occurred in this series, one early mortality due to uncontrolled upper gastrointestinal bleeding and one late mortality following massive pulmonary embolism. Conclusions: Laparoscopic radical cystectomy is a safe operation with morbidity and mortality rates comparable to the open surgery.

Laparoscopic Radical Cystectomy: a 5-year review of a single institute's operative data and complications and a systematic review of the literature

“…All articles excluded were due to either non-relevance to the aim of this review or reported on less than 50 LRC. Seven articles were included, their results are depicted on Table-4 (10)(11)(12)(13)(14)(15)(16)(17). No studies were found describing the learning curve for laparoscopic cystectomy procedures.…”

Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery

“…Частота развития динамической непроходимости составила 23 % при ОЦЭ, 3 % при ЛЦЭ и 8 % при РАЦЭ [4,27]. Однако встречаемость этого осложнения во многом зависит от определения.…”

Cistectomía radical laparoscópica: técnica y resultados en 100 pacientes consecutivos

“…Es por ello que los pasos quirúrgicos empleados en ambas cirugías son similares. De esto se desprende que las posibles complicaciones de la vía laparoscópica estarán únicamente relacionadas con el tipo de abordaje y no con una cirugía diferente 18 . Las complicaciones reportadas por Ukimura y col 19 , sobre la experiencia inicial de 21 casos en la Cleveland Clinic muestran un 29% de complicaciones mayores (requirieron reoperación) y un 45% de complicaciones menores (relacionadas a íleo prolongado).…”