Abstract
Background
Radical cystectomy with urinary diversion is the current gold standard procedure for muscle-invasive bladder cancer. However, laparoscopic radical cystectomy (LRC) has evolved rapidly worldwide during the past decade, despite its complexity due to both the demolitive step with management of a highly aggressive cancer and the reconstructive step. The authors performed a survey to assess the Italian experience with LRC and urinary diversion in an effort to point out the volume of the procedure in their country, providing some surgical details.
Methods
A total of 10 Italian urologic departments with experts in laparoscopic urologic surgery were contacted and asked to participate in a two-page survey concerning indications for cystectomy, laparoscopic technique, intra- and postoperative complications, and follow-up evaluation of the procedure when available.
Results
Five sites elected to participate, and a total of 83 LRCs were collected. All centers used five trocar ports. The mean operative time was 8 h and 40 min, and the estimated blood loss was 376 ml. In two cases, the procedure was converted to open surgery. Postoperative complications consisted of one urinary leakage, one fistula, and one atrium rupture. A retrieval sac was used in all cases. Urinary diversions consisted of 43 ileal conduits, 26 orthotopic diversions, and 14 other techniques. The mean follow-up period was 9 months (range, 1–36 months). No tumor seeding was recorded.
Conclusions
The LRC procedure is feasible although technically demanding. The morbidity of this procedure is evident, but may be reduced with further experience. Bowel management and reconstruction remain the most challenging part of the procedure.
Similar content being viewed by others
References
Abdel-Hakim AM, Bassiouny F, Abdel MS (2002) Laparoscopic radical cystectomy with orthotopic neobladder. J Endourol 16: 377–381
Anderson KR, Fadden PT, Kerbl K, McDougall EM, Clayman RV (1995) Laparoscopic assisted continent urinary diversion in the pig. J Urol 154: 1934–1938
Balduin DD, Herrel SD (2003) Simplified laparoscopic radical cystectomy with orthotopic ileal neobladder creation in a porcine model. J Endourol 17: 307–312
Carrion R, Seigne J (2002) Surgical management of bladder carcinoma. Can Control 4: 284–292
Cestari A, Naspro R, Riva M, Bellinzoni P, Nava L, Rigatti P, Guazzoni G (2005) Nerve-sparing laparoscopic cystectomy. Curr Urol Rep 6: 101–105
Sanchez de Badajoz E, Gallego Perales JL, Reche Rosado A, Gutierrez de la Cruz JM, Jimenez Garrido A (1995) Laparoscopic cystectomy and ileal conduit: case report. J Endourol 9: 59
Deger S. Tuerk IA, Loening SA (2004) Laparoscopic radical cystectomy with continent urinary diversion (rectosigmoid pouch) performed completely intracorporeally: an intermediate functional and oncologic analysis. Urology 64: 935–939
El Tabey NA, Shoma AM (2005) Port-site metastases after robot-assisted laparoscopic radical radical cystectomy. Urology 66: 1110
Gill IS, Fergany A, Klein EA, Kaouk JH, Sung GT, Meraney AM, Savage SJ, Ulchaker JC, Novick AC (2000) Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology 56: 26–30
Gill IS, Kaouk JH, Meraney AM, Desai MM, Ulchaker JC, Klein EA, Savage SJ, Sung GT (2002) Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorporeally: the initial experience. J Urol 168: 13–18
Hemal AK, Iqbal Singh F (2003) Laparoscopic radical cystectomy and ileal conduit reconstruction: preliminary experience. J Endourol 17: 911–916
Kaouk JH, Gill IS, et al. (2001) Laparoscopic orthotopic ileal neobladder. J Endourol 15: 131–142
Kozminski M, Partamian KO (1992) Case report of laparoscopic ileal loop conduit. J Endourol 6: 147
Matin SF, Gill IS (2002) Laparoscopic radical cystectomy with urinary diversion: completely intracorporeal technique. J Endourol 16: 335–340
Micali S, Celia A, Bove P, De Stefani S, Sighinolfi MC, Kavoussi LR, Bianchi G (2004) Tumor seeding in urological laparoscopy: an international survey. J Urol 171: 251–254
Parra RO, Andrus CH, Jones JP, Boullier JA (1992) Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol 148: 1140–1044
Potter SR, Charambura TC, Adams JB II, Kavoussi LR (2000) Laparoscopic ileal conduit: five-year follow-up. Urology 56: 22–25
Smith JA (2005) Laparoscopic radical cystectomy with continent urinary diversion (rectosigmoid pouch) performed completely intracorporeally: an intermediate functional and oncologic analysis. J Urol 174: 483–488
Turk I, Deger S, Winkelmann B, Schonberger B, Loening SA (2001) Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: the initial 5 cases. J Urol 165: 1863–1866
Acknowledgment
We acknowledge the assistance of Vincenzo Disanto, Franco Gaboardi, Giorgio Guazzoni, Fondazione Vincenzo Pansadoro, and Francesco Porpiglia.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sighinolfi, M.C., Micali, S., Celia, A. et al. Laparoscopic radical cystectomy: an Italian survey. Surg Endosc 21, 1308–1311 (2007). https://doi.org/10.1007/s00464-006-9086-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-006-9086-7