Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases

doi:10.1016/S0090-4295(00)00598-7

Urology

Volume 56, Issue 1, July 2000, Pages 26-29

https://doi.org/10.1016/S0090-4295(00)00598-7 Get rights and content

Abstract

Objectives. To present the initial 2 patients who underwent laparoscopic radical cystoprostatectomy, bilateral pelvic lymphadenectomy, and ileal conduit urinary diversion, with the entire procedure performed exclusively by intracorporeal laparoscopic techniques.

Methods. Two male patients, 78 and 70 years old, with muscle-invasive, organ-confined, transitional cell carcinoma of the urinary bladder underwent the procedure. The entire procedure, including radical cystoprostatectomy, pelvic node dissection, isolation of the ileal loop, restoration of bowel continuity with stapled side-to-side ileoileal anastomosis, retroperitoneal transfer of the left ureter to the right side, and bilateral stented ileoureteral anastomoses were all performed exclusively by intracorporeal laparoscopic techniques. Free-hand laparoscopic suturing and in situ knot-tying techniques were used exclusively.

Results. The surgical time was 11.5 hours in the first patient and 10 hours in the second. The respective blood loss was 1200 mL and 1000 mL. In both patients, ambulation resumed on postoperative day 2, bowel sounds on day 3, and oral intake on day 4; the hospital stay was 6 days. Narcotic analgesia comprised 108.3 mg and 16.5 mg of morphine sulfate equivalent, respectively. Pathologic examination revealed pT4N0M0 (prostate) and pT2bN0M0 transitional cell carcinoma of the bladder with the surgical margins negative for cancer in both patients. No intraoperative or postoperative complications occurred in either patient.

Conclusions. To our knowledge, this is the initial report of laparoscopic radical cystoprostatectomy with intracorporeal ileal conduit urinary diversion. We believe that with further experience and refinement in the operative technique, laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion may become an attractive treatment option for selected candidates with localized muscle-invasive bladder cancer.

Section snippets

Material and methods

Two men, 78 and 70 years old, were diagnosed with grade III muscle-invasive transitional cell carcinoma of the urinary bladder. The Anesthesiology Society of America class was 3 for both patients, and their respective body mass index was 28 and 25. Abdominal computed tomography ruled out evidence of extravesical involvement. After detailed informed consent was given, laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion was performed on January 11 in the first patient and

Results

Both procedures were completed laparoscopically without intraoperative or postoperative complications. The total surgical time (from initial skin incision to final skin stitch) was 11.5 hours in the first patient and 10 hours in the second. The estimated blood loss was 1200 mL in the first patient and 1000 mL in the second; the initial patient was transfused with 2 U of blood. Both patients resumed ambulation on day 2, bowel sounds on day 3, and oral intake on day 4 and were discharged from the

Comment

Laparoscopic simple cystectomy was initially reported by Parra and colleagues1 for benign, recurrent, symptomatic pyocystis of a retained bladder in a 27-year-old woman with post-traumatic paraplegia, who had 5 months previously undergone open surgical ileocolonic reservoir creation with a continent stoma. The surgical time was 130 minutes, the blood loss was 115 mL, the specimen weight was 21.9 g, and her hospital stay was 5 days. Kozminski and Partamian6 initially reported a

Conclusions

This initial report attests that laparoscopic radical cystoprostatectomy and completely intracorporeal ileal conduit urinary diversion are possible, while maintaining established oncologic and reconstructive principles. With increasing experience, we believe that the operative times will decrease and enable wider application of this procedure.

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To compare perioperative results of intracorporeal ileal conduit (ICIC) and intracorporeal orthotopic neobladder (ICONB) following laparoscopic radical cystectomy.
A total of 51 ICIC patients and 32 ICONB patients were included. Propensity score matching was performed based on: age, body mass index, gender, age-adjusted Charlson comorbidity index, history of neoadjuvant chemotherapy, history of abdominal surgery, history of smoking and enhanced recovery protocols. Primary outcomes were length of stay and 30-day complications. Secondary outcomes were operative time and estimated blood loss.
ICONB was more likely to be performed in younger patients (P < 0.001). Other baseline characteristics in the 2 groups were similar (P > 0.05). ICIC showed shorter length of stay (11 days vs. 14 days, P = 0.031) and faster pelvic drainage tube removal (6 days vs. 9 days, P = 0.014). Operative time, estimated blood loss, 30-day complications were similar in the 2 groups (P > 0.05). However, postoperative fever was significantly lower in ICIC group (19.6% vs. 62.5%, P < 0.001). After propensity score matching, ICIC still showed shorter length of stay (10 days vs. 15 days, P = 0.002) and less postoperative fever (15% vs. 65%, P = 0.003). In multivariable analysis, ICONB was independently associated with length of stay≥14 days and postoperative fever both before and after propensity score matching (P < 0.05).
In our research, ICONB was more likely to be performed in younger patients. ICIC and ICONB showed no difference on 30-day complications, operative time and estimated blood loss. ICIC group showed shorter length of stay, faster pelvic drainage tube removal and less postoperative fever.
Totally intracorporeal robot-assisted urinary diversion for bladder cancer (Part 1). Review and detailed characterization of ileal conduit and modified Indiana pouch
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To review the most used robot-assisted cutaneous urinary diversion (CUD) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images
A non-systematic review of the literature with the keywords “bladder cancer”, “cutaneous urinary diversion”, and “radical cystectomy” was performed.
Twenty-four studies of intracorporeal ileal conduit (ICIC) and two of intracorporeal Indiana pouch (ICIP) were included in the analysis. Regarding ICIC, the patients’ age ranged from 60 to 76 years. The operative time to perform a urinary diversion ranged from 60 to 133 min. The total estimated blood loss ranged from 200 to 1 117 mL. The rate of positive surgical margins ranged from 0% to 14.3%. Early minor and major complication rates ranged from 0% to 71.4% and from 0% to 53.4%, respectively. Late minor and major complication rates ranged from 0% to 66% and from 0% to 32%, respectively. Totally ICIP data are limited to one case report and one clinical series.
The most frequent type of CUD is ICIC. Randomized studies comparing the performance of the different types of CUD, the performance in an intra- or extracorporeal manner, or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature. To this day, there are not enough quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images for each technique.
Single-port Robotic Intracorporeal Ileal Conduit Urinary Diversion During Radical Cystectomy Using the SP Surgical System: Step-by-step Technique
2019, Urology
Citation Excerpt :
We presented herein the first clinical description of the technique for a totally intracorporeal single-port robot-assisted ileal conduit urinary diversion after RARC. Gill et al was the first to report 2 cases of laparoscopic radical cystoprostatectomy with intracorporeal ileal conduit urinary diversion.11 Technical challenges on laparoscopy demanded a long learning curve, restricting the wide diffusion of the procedure in the field.
To describe the step-by-step technique for robotic intracorporeal ileal conduit urinary diversion (ICUD) following radical cystectomy performed by using the novel da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA).
Four consecutive patients (2 males and 2 females) were initially counseled for robotic cystectomy with ICUD performed by using the da Vinci SP surgical system. Surgeries were performed by duplicating the steps of the institutional approach for intracorporeal ICUD performed with the multiarms robotic platform. Perioperative outcomes were analyzed. Data were collected under institutional review board approval (IRB 13-780).
Single-port robot-assisted radical cystectomy with ICUD was successfully completed in 3 patients (2 males and 1 female). Mean robotic operative time for ICUD was 75 minutes (range 67-90). There was no conversion to standard multiarms robotic approach. One patient needed to be converted to extracorporeal urinary diversion due to severe adhesions of small bowels. No additional ports were placed. Neither transfusions nor intraoperative complications occurred. All patients were discharged on postoperative day 5. One patient reported self-limited nausea and vomiting after discharge (Clavien grade I).
In our preliminary experience, ICUD after robot-assisted radical cystectomy is feasible using the da Vinci SP surgical system. Further comparative studies with open and multiarms robotic approaches are warranted.
Laparoscopic Radical Cystectomy With Extracorporeal Neobladder: Our Initial Experience
2019, Urology
To illustrate our technique to construct the Institute of Urology Peking University (IUPU) orthotopic ileal bladder and present our initial experience.
From August 2017 to April 2018, 12 patients with bladder cancer underwent radical cystectomy (RC), pelvic lymph node dissection and extracorporeal construction of an IUPU neobladder (IUPUB) by an experienced surgeon. We present the demographic, clinicopathologic, perioperative, and follow-up data. We also describe our step-by-step surgical technique for the IUPUB in this article.
Laparoscopic RC with an extracorporeal IUPUB was successfully accomplished in 11 patients, and 1 patient was converted to open RC with an IUPUB. The median total operative time and median time spent suturing the pouch were 248 minutes and 23 minutes, respectively. The median estimated blood loss was 150 mL. The median time to recovery of bowel function (tolerance of a liquid diet) was 3½ days. The urinary catheter was removed on post-operative day 21 in 10 patients. The ureteral stents and stoma catheter were removed on day 7 after cystography. At a median followup of 7½ months, 2 patients had early complications (<30 days), and no major complications (grade ≥ 3) occurred. The follow-up outcomes were satisfactory. The limitations included the small sample size and short-term outcomes.
Our technique of constructing the IUPUB is feasible and safe. The operative time and early complication rates are acceptable.
Robotic Cystectomy
2018, Urologic Clinics of North America
Citation Excerpt :
Robotic-assisted laparoscopic radical cystectomy (RARC) was first described in 2003,1 predated by case reports of laparoscopic radical cystectomies in 19952 and intracorporeal ileal conduit urinary diversion (UD) 5 years later in 2000.3
Post-surgical complications in patients with bladder cancer treated with cystectomy: Differences between open and laparoscopic approach
2019, Actas Urologicas Espanolas
La cirugía mínimamente invasiva en la cistectomía no ha tenido el mismo desarrollo que en otras cirugías urológicas, entre otros motivos por la falta de estudios publicados que definan las ventajas de este abordaje frente a la cirugía abierta.
El principal objetivo de este estudio es establecer el papel de la cirugía mínimamente invasiva, laparoscopia, en la cistectomía radical frente a la cirugía abierta en un análisis de complicaciones perioperatorias.
Análisis de cohortes retrospectivo de complicaciones perioperatorias de 2 series homogéneas de cistectomías: laparoscópica (n = 196) frente a abierta (n = 197). Identificación mediante análisis multivariante de factores independientes predictores de complicaciones perioperatorias.
En el análisis comparativo entre el abordaje laparoscópico y el abierto observamos una menor tasas de trasfusión perioperatoria (p < 0,0001), una menor tasa de complicaciones postoperatorias globales (p < 0,0001) así como en el subgrupo de complicaciones graves (Clavien > 3; p < 0,001). También una menor tasa de mortalidad en la serie de laparoscópica frente a la abierta (p < 0,0001). Identificamos como factor independiente predictor de complicaciones al abordaje quirúrgico y la duración de la cirugía (p < 0,001).
En nuestro estudio identificamos el abordaje laparoscópico como protector de complicaciones en la cistectomía radical. El abordaje abierto casi triplica el riesgo de tener complicaciones.
Minimally invasive surgery regarding cystectomy has not had the same development as other urological surgeries. This could be due to the lack of published studies defining the advantages of this approach versus open surgery.
The main objective of this study is to establish the role of minimally invasive surgery, laparoscopic radical cystectomy, versus open surgery by analyzing their perioperative complications.
Retrospective cohort analysis of perioperative complications of 2 homogeneous series of cystectomies: laparoscopic (n = 196) versus open (n = 197). Identification of independent predictors of perioperative complications by multivariate analysis.
In the comparative analysis between laparoscopic cystectomies and open cystectomies we observed a lower rate of perioperative blood transfusion (P < 0.0001), a lower rate of global postoperative complications (P < 0.0001) and a lower rate of serious complications (Clavien > 3; P < 0.001) in the LRC group. There was also a lower mortality rate in the laparoscopic series compared to open ones (P < 0.0001). Surgical approach and surgical time (P < 0.001) were identified as independent predictors of complications.
We have identified the laparoscopic approach as a complication shield for radical cystectomy. The open approach almost triples the risk of complications.

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Rapid communicationLaparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases

Abstract

Section snippets

Material and methods

Results

Comment

Conclusions

J Urol

Urology

J Urol

Laparoscopic cystectomy and ileal conduitcase report

J Endourol

Rapid communication
Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases