Laparoscopic partial cystectomy in bladder cancer: initial experience

Abstract

Proposal: The authors present their initial experience with a selected group of patients who underwent laparoscopic partial cystectomy for treating bladder cancer.Materials and Methods: In the period from June 1997 to April 2000, 6 patients, aged between 38 and 76 years, having transitional cell carcinoma of the bladder, were identified as candidates to partial cystectomy. The procedure employed consisted in laparoscopic partial cystectomy and lymphadenectomy with exclusive intracorporeal suture technique.Results: The proposed procedure was completed in all cases. Mean surgical time was 205 minutes and mean blood loss was 200 mL. There were no significant complications during both intraand post-operative period. Two patients (33%) presented urinary extravasation of less than 50 mL, with spontaneous resolution. Mean hospitalization period was 4 days (2 to 6). The histological analysis of the resected specimens revealed transitional cell carcinoma, stage pT1G3 in case 1, pT2aG2 in cases 2 to 4, pT2bG2 in case 5 and pT3aG3 in case 6. The resection margins, as well as lymph nodes, were free of neoplasia. One patient developed local and metastatic disease, and was treated with salvage chemotherapy. No other case of local or systemic recurrence was observed with a mean follow-up of 30 months.Conclusions: Laparoscopic partial cystectomy can be an alternative surgical method for treating selected cases of patients with transitional cell carcinoma of the bladder.

Stapleless Laparoscopic Assisted Radical Cystectomy With Ileal Neobladder in a Male and With Ileal Loop in a Female: Initial Report From Brazil

“…Although this represents our initial experience with laparoscopic radical cystectomy, our group has familiarity with major laparoscopic surgery, including more than 25 laparoscopic radical prostatectomies successfully performed in the past year. This is in line with the majority of authors that do not recommend laparoscopic radical cystectomy before the surgeon has properly mastered the technique of laparoscopic radical prostatectomy (11). Whereas creation of the neobladder following laparoscopic cystectomy through a 12 cm Pfannensteil incision poses no significant difference to what is routinely performed during open surgery.…”

Laparoscopic radical prostatectomy: 10 years experience

“…Mortality has reported to be approximately from 0.5 to 1%, and has been related to heart diseases or cases of pulmonary embolism. All reported series on LRP show a tendency towards the reduction of postoperative complication rates, from 25% to approximately 5% after the learning curve has been achieved (3,5,6,10,(12)(13)(14)(15)(16)(17).…”

“…Laparoscopy offers increased magnification, excellent illumination and a tamponade effect of CO 2 , which facilitates hemostasis and visualization. Safe ligation of the dorsal vein complex is performed under good anterior and lateral visualization of the venous plexus and of its lower limit, close to the urethra (1)(2)(3)(4)(5)(6)(8)(9)(10)(11)(12).…”

“…Different types of complications have been reported in up to 35% of the cases, but most of them have negligible clinical consequences (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Mortality has reported to be approximately from 0.5 to 1%, and has been related to heart diseases or cases of pulmonary embolism.…”

“…Ureteral injuries yield rates of 0.5% in LRP, and occurs mainly in three situations: 1) when we mistake the vas deferens for the ureter; 2) when a previous transurethral resection was made, which prevents the proper visualization of ureteral meatus at the bladder neck; 3) when the ureter is enveloped by a urethrovesical anastomosis (2,5,10,12,15). Treatment usually consists of laparoscopic ureteral reimplantation.…”