Mini‐laparotomy approach to radical cystectomy

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? In the recent decade minimally invasive endoscopically approaches have been suggested as a way to reduce morbidity following radical cystectomy. The present study suggests that the same advantages found, when comparing endoscopical cystectomy to classical open cystectomy, can be achieved by reducing the wound length of the open approach. OBJECTIVE To investigate the feasibility of performing radical cystectomy (RC) through a mini‐laparotomy and to evaluate the effect of a smaller incision on wound problems, immediate postoperative pain, bowel function and length of hospital stay (LOS). PATIENTS AND METHODS Two consecutive cohorts of patients, one with 75 patients undergoing open RC (ORC) with lymph node dissection up to the aortic bifurcation through a conventional long midline incision and one with 75 patients undergoing RC through a mini‐laparotomy (MinilapRC) of intentionally <8–10 cm. Patient characteristics, operative duration, estimated blood loss (EBL), incidence and severity of wound problems, return of bowel function, amount of analgesics needed and LOS were analysed according to the intention‐to‐treat principle. RESULTS The demographic characteristics of the two groups were similar. An incision of ≤10 cm was made in 65% of the patients in the MinilapRC group with a median (range) length of incision of 9 (6.5–19) cm. In the final third of patients operated on in the MinilapRC group, 76% had an incision of ≤8 cm. The operative duration and EBL were not significantly different between the groups. Wound problems were significantly fewer, bowel function was restored more quickly and the need of postoperative analgesics was less in the MinilapRC group. In the MinilapRC group LOS was reduced by a median of 3 days. CONCLUSION MinilapRC is feasible in most patients without increasing operative duration. The reduced incision length reduces postoperative morbidity.

Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial

“…A minilaparotomy RC was performed with/without robot assistance based on department capacity, patient characteristics, and patient preferences 18. All patients underwent nutritional screening and counseling, and in case of risk the patients recieved oral nutritional supplements according to the best European practices 19.…”

Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial

“…The minilab procedure was introduced and implemented during 2009 and 2010, which was shortly before the current study began. This minimally invasive procedure was later reported to have a significant positive impact, reducing the median LOS from 11 days in 2009 to 8 days by the end of 2010 [26]. This unexpected high efficacy may have invalidated the pretrial power estimation and the potential benefits on LOS.…”

Radical cystectomy in octogenarians

“…[2] Now radical cystectomy and ileal conduit can be performed with an acceptable morbidity and mortality in individuals 80 years of age or older[1] with no statistically significant difference with respect to age. [34] Prolonged hospital stay can be avoided by minimizing the size of incision and performing extraperitoneal radical cystectomy,[56] which helps in early restoration of bowel function as it minimizes bowel handling with decreased postoperative pain.…”