Korean J Urol.  2007 Sep;48(9):938-944. 10.4111/kju.2007.48.9.938.

Short Term Outcomes of Laparoscopic Radical Cystectomy with an Extracorporeal Ileal Conduit: Comparative Analysis with the Open Method

• Kwak JJ
• Kim TH
• Sung GT

• KMID: 2061295
• DOI: http://doi.org/10.4111/kju.2007.48.9.938

Abstract

PURPOSE
We analyzed the perioperative and early oncological outcomes following radical cystectomy with using the laparoscopic method, and we compared these findings with those of the conventional open method.
MATERIALS AND METHODS
Between January 2003 and December 2006, we performed laparoscopic radical cystectomy(LRC) with an extracorporeal ileal conduit for treating bladder cancer in 22 patients, and the results of the LRC were compared with those of open radical cystectomy(ORC) in 20 cases. The surgical results such as the operation time, the estimated blood loss(EBL), the transfusion rate, the hospital stay, the complications and the oncological results were reviewed retrospectively and then analyzed via the Mann-Whitney U test.
RESULTS
There were no significant differences of demographic data between the two groups. The pathologic reports showed a transitional cell type in all cases. For the LRC and ORC groups, the mean operation time for cystectomy was 186.5 min(150-240) vs 192.4 min(150-240), respectively (p=0.276), the EBL was 228.18ml(150-380) vs 995.0ml(400-1,200), respectively(p<0.01), the transfusion rate was 15.7% vs 85.0%, respectively, the hospital stay was 11.2 days vs 12.4 days, respectively(p=0.67), the intraoperative complications was 3/22 cases(13.6%) vs 9/20 cases(45.0%), respectively. The pathologic surgical margins were all negative. The surgical and pathologic parameters of the LRC group showed no significant differences compared to those of the ORC group, except for the EBL and transfusion rate.
CONCLUSIONS
LRC resulted in less blood loss, a lower transfusion rate and earlier, more rapid recovery than did ORC. In our opinion, lararoscopic surgery is a feasible treatment for bladder cancer.

Keyword

Bladder cancer; Laparoscopy; Cystectomy

MeSH Terms

Cystectomy*
Humans
Intraoperative Complications
Laparoscopy
Length of Stay
Retrospective Studies
Urinary Bladder Neoplasms
Urinary Diversion*

Figure

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  Fig. 1. Dissection of Denonvillier's fascia between the prostate and rectum.

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  Fig. 2. Control of the lateral vascular pedicle of the bladder using EndoGIA.

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  Fig. 3. Dissection of the ureter up to the ureterovesical junction, and then the ureter was clipped.

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  Fig. 4. After the incision of the endopelvic fascia, the lateral pedicle of the prostate up to the apex was controlled and dissected.

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  Fig. 5. Ligation of the deep dorsal vein of the prostate using LigaSure.

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  Fig. 6. After dissecting beneath the sigmoid colon, we transported the left ureter from left to right through the sigmoid colon.

Reference

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