Laparoscopic radical cystectomy with pelvic re-peritonealization: the technique and initial clinical outcomes

Abstract

BackgroundDelayed bowel function recovery and postoperative ileus are relatively serious complications of laparoscopic radical cystectomy (LRC). Our study aimed to determine whether performing pelvic re-peritonealization reduces the incidence of these complications.MethodsClinical data of 78 patients who had undergone LRC with pelvic re-peritonealization from August 2015 to December 2017 were retrospectively collected and compared with those of 92 patients who had undergone LRC alone between January 2013 and July 2015 in our institution. Differences in duration of surgery, estimated blood loss, time to recovery of bowel function, the complications of intestinal and blood vessel injury, and incidence of postoperative ileus between the two groups were analyzed.ResultsBaseline characteristics such as age, sex and BMI were balanced between the two groups. There were no significant differences in duration of surgery (P = 0.072), estimated blood loss (P = 0.717), or incidence of intestinal obstruction (P = 0.225) between the two groups. Interestingly, patients who had undergone pelvic re-peritonealization recovered bowel function more rapidly than those had not (2.79 d vs. 3.72 d, P = 0.001). Additionally, hospitalization stay was significantly shorter for patients with re-peritonealization than for those without (5.46 d vs. 6.68 d, P = 0.029).ConclusionsCompared with LRC alone, LRC with pelvic re-peritonealization as described in the present study had comparable perioperative complications, but was associated with more rapid gastrointestinal recovery and shorter hospitalization stay.

Is it necessary to perform a retrosigmoid transposition of the left ureter in Bricker Ileal Conduit surgery?

“…All operations were performed by the same laparoscopic surgical team (Yu D and Bi L). The laparoscopic radical cystectomy (LRC) and pelvic lymph node dissection were performed by the standard laparoscopic technique [ 9 ], and pelvic re-peritonealization was also completed based on the technique previously described [ 10 ]. The ileal conduit was constructed according to Bricker’s technique [ 3 ], while the left ureter is mobilized and transposed using our ground-breaking method.…”

Initial experience with 161 extraperitoneal laparoscopic radical cystectomy procedures: Comparison with transabdominal laparoscopic radical cystectomy

“…With the advent and development of laparoscopic RC (LRC) and robot‐assisted RC (RARC), both minimally invasive modalities, blood loss, transfusion rates, length of stay, and postoperative pain have been significantly reduced and the rapid recovery of postoperative bowel function facilitated 2,3 . Nevertheless, due to adhesions of the intestine to the pelvic surgical field, even patients undergoing minimally invasive RC surgery still suffer complications, with adhesive ileus continuing to be common 4 . In 1999, Kulkarni 5 first reported RC surgery using an extraperitoneal approach.…”

“… 2 , 3 Nevertheless, due to adhesions of the intestine to the pelvic surgical field, even patients undergoing minimally invasive RC surgery still suffer complications, with adhesive ileus continuing to be common. 4 In 1999, Kulkarni 5 first reported RC surgery using an extraperitoneal approach. Over the past two decades, a number of surgeons have modified this method, aiming to reduce the associated postoperative morbidity and rates of complications.…”