Laparoscopic Assisted Radical Cystectomy With Ileal Neobladder: A Comparison With the Open Approach

Basillote, Jay; Abdelshehid, Corollos; Ahlering, Thomas E.; Shanberg, Allan M.

doi:10.1097/01.ju.0000129662.83162.2e

Cited by 134 publications

(74 citation statements)

References 14 publications

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“…This is in line with what have been previously reported by Basillote et al that had to convert a laparoscopic procedure due to the markedly enlarged size (10 cm) of the bladder tumor arising in posterior bladder wall that preclude the posterior dissection between the prostate and rectum safely (7). Based on this experience, we believe that the tumor size (high-volume tumors) is an important criteria for proper patient selection and may represent relative or even a formal contraindication for the laparoscopic approach.…”

Section: Discussionsupporting

confidence: 76%

“…In our series, the overall incidence of complications was 42%, being 7 intraoperative (12%) and 18 postoperative (30%), which is comparable to the 30.5% of complications (only postoperative complica- tions) that were found after studying 2,538 subjects that underwent open radical cystectomy, with ileus in 9.7%, urinary tract infection in 7.8%, dehiscence in 5.5%, wound infection in 5.2%, and postoperative hemorrhage in 1.8%, requiring transfusion greater than 4 units within 72 hours postoperatively (8). In fact, in a review of 152 laparoscopic radical cystectomies performed at 5 centers, the mean operative time was 398 minutes and the mean blood loss was 605 mL (7,(9)(10)(11)(12). Twenty eight complications occurred (18.5%), including 1 dehydration, 1 obturator nerve paresis, 1 pelvic infection, 4 urinary tract infection, 1 injury to the external iliac vein, 1 subcutaneous emphysema in one patient with hypercarbia, 2 pulmonary embolism, 5 urinary fistulas (1 case of neobladder to vagina fistula), 3 hematomas, 1 ureteral obstruction secondary to misplaced ureteral catheter, 1 bladder neck contracture, 1 epididymal abscess, 1 wound dehiscence, 1 internal hernia requiring laparotomy 19 days postoperatively, 2 small rectal tears and 2 partial small bowel obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The uretero-intestinal anastomosis were also performed using conventional open surgical techniques except in 2 cases of ileal neobladder, 1 totally intra-corporeally constructed and 1 in which the ureters did not reach the Pfannenstiel incision and had to be anastomosed to neobladder using free hand laparoscopic suturing. The ureterointestinal anastomosis was performed open surgically in only one (through an extended 12 cm Pfannenstiel incision) case as described by Basillote (7). In the other cases, the recently fashioned reservoir was reintroduced into the abdominal cavity, pneumoperitoneum was restored and the urethra-intestinal anastomosis was preformed laparoscopically.…”

Section: Methodsmentioning

confidence: 99%

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

Castillo

Abreu²,

Mariano

et al. 2006

Int. braz j urol.

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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.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Castillo

Abreu²,

Mariano

et al. 2006

Int. braz j urol.

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show abstract

“…Several reports have formerly been published that compare LRC and ORC, in which the pain scores and analgesic requirements in the LRC group were significantly lower than those in the ORC group. 9,[14][15][16] It is inferred that the reduced analgesic consumption, reflecting less pain, promoted the earlier recovery of bowel function and return to normal activity.…”

mentioning

confidence: 99%

Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid‐term oncological outcome

Kim

et al. 2009

Int J of Urology

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Results: Median follow-up of the LRC group was 21 months (3-56 months). Pathological stage or grade was similar in the two groups. There was no significant difference between the LRC and ORC groups in terms of 3-year overall (64.2% vs 72.6%, respectively; P = 0.682), cancer-specific (73.0% vs 75.3%, respectively; P = 0.951), and recurrence-free survival (70.5% vs 72.5%, respectively; P = 0.715) rates. In a subgroup analysis according to stage, there was also no significant difference in the 3-year disease-specific survival after LRC or ORC for organ-confined (pT1 and pT2; 85.7% vs 83.9%, respectively; P = 0.256) or extravesical disease (pT3 and pT4; 73.3% vs 63.8%, respectively; P = 0.825). Conclusion: These findings suggest that LRC provides mid-term oncological outcomes similar to those of ORC in the management of bladder cancer.

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“…1 The first laparoscopic radical cystectomy (LRC) was reported in 1995 by Sánchez de Badajoz et al 2 LRC was performed in an increasing number of centers, and major short-term patient-related benefits, such as less estimated blood loss, earlier return of bowel function and shorter length of stay, had been reported in nearly all studies of LRC. [3][4][5] However, LRC is not routine for most urologists because it is difficult to learn and there is a notable learning curve with LRC. 6 In addition, the surgeon should have experience of laparoscopic radical prostatectomy.…”

Section: Introductionmentioning

confidence: 99%

Hand‐assisted versus pure laparoscopic radical cystectomy: A clinical outcome comparison

Wang

Chen

et al. 2009

Int J of Urology

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Objectives:To compare hand-assisted laparoscopic radical cystectomy (HALRC) with the standard laparoscopic radical cystectomy (LRC) in an attempt to delineate their role in bladder cancer treatment. Methods: We retrospectively analyzed 51 patients who underwent HALRC (HALRC group, 31 cases) or LRC (LRC group, 20 cases). Urinary diversion was performed extracorporeally through the hand port or the incision for specimen retrieval, respectively, in the two groups. Baseline patient characteristics, intraoperative parameters, and postoperative outcomes were evaluated. Results: There was no statistically significant difference in age, sex, body mass index, previous abdominal surgeries, or tumor stage between the two groups. Although the LRC group yielded a significantly smaller incision for urinary diversion than the HALRC group (7.3 cm vs 6.2 cm, P < 0.05), mean operative time, mean estimated blood loss, blood transfusion rate, time to oral intake and complications were similar in the two groups. Hernia formation was observed with increased frequency in the HALRC group. No patients in the HALRC group and only one patient (5%) in the LRC group presented a positive margin. Conclusions:The HALRC group yielded the same outcomes as the LRC group, except with a larger incision. The hand-assisted approach might be preferred for obese patients or those having multiple previous abdominal surgeries.

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Laparoscopic Assisted Radical Cystectomy With Ileal Neobladder: A Comparison With the Open Approach

Abstract: LACINB is a feasible and reproducible procedure, which results in decreased postoperative pain and quicker recovery without a significant increase in operative time. However, longer followup is needed to assess long-term oncological and functional outcomes.

Cited by 134 publications

References 14 publications

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

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

Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid‐term oncological outcome

Hand‐assisted versus pure laparoscopic radical cystectomy: A clinical outcome comparison

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