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Ces Urol 2016; 20(2): 100–103
VIDEO
SUMMARY
Balík M, Košina J, Špaček J, Vachata S, Pacovský J,
Hušek P, Holub L, Broďák M. Laparoscopic radical
cystectomy – video 2015.
Goals
: Minimally invasive approaches in onco-
logical surgery are associated with less morbidity
without compromising oncological results. We
present our video from a laparoscopic radical cys-
tectomy in a male patient.
Methods
: We start procedure in Trendelen-
burg position creating capnoperitoneum by Veres
needle through small incision above umbilicus. We
use umbilical camera port, 1 x 10 mm and 3 x 5 mm
working ports around the line between umbilicus
and iliac spine. We start with pelvic lymph node
dissection on both sides, removing lipo-lymphatic
tissue around common iliac vessels and from obtu-
rator fossa. We identify psoas muscle, genitofemo-
ral nerve, common iliac vessels, obturator nerve
and ureter. After deliberation of lateral aspect of
bladder and prostate (through endopelvic fascia)
we dissect ureter as far as possible and after clip-
ping we sent the specimen for frozen section. Next
step is prophylactic appendectomy. We continue
dissection of bladder and prostate with seminal
vesicles from rectum. Isolated pedicles of blad-
der and prostate are interrupted by diathermy
and clips. Specimen is removed by dissection in
prevesical fat and cutting puboprostatic ligaments
and urethra just below the apex of prostate. Final
step after suturing urethra is transposition of left
ureter through sigmoid mesocolon to the right
side. If frozen section is negative, we continue with
creation of urinary diversion through 5–7 cm long
minilaparotomy around the umbilicus.
Results
: From April 2014 to September 2015
we performed 13 laparoscopic radical cystecto-
mies in male patients for invasive or endoscopically
untreatable urothelial bladder carcinoma. Mean
age was 64 (52–74) years, body mass index 27.7
(21.7–40.3). We created 12 ileal conduits and 1 con-
tinent orthotopic diversion. Mean operation time
was 359 minutes (250–420). Mean blood loss was
268 ml (100–1000). No blood transfusion was ad-
ministered. No prolonged lymphatic secretion from
drains or wounds was observed. Average length of
hospitalization was 15.6 days (11–30). One patient
died 7 months after procedure because of renal
failure with no harm on higher urinary tract. One
patient died 9 months after procedure because
of recurrence of urothelial carcinoma. Most seri-
ous complication within 90 days after procedure
was distal ureter necrosis managed by reoperation
(Dindo-Clavien IIIb). We observed no paralytic ileus
or secondary wound healing.
In this video we present the procedure in a 70
year old male patient with body mass index 26,9.
Initial histology findings from transurethral biopsy
made in November 2014 were invasive urothelial
carcinoma pT2 grade 3 (high grade). There were
no distant metastases observed. The patient un-
derwent 4 cycles of neoadjuvant chemotherapy
(doxorubicine + cisplatine). Procedure was per-
formed in May 2015 lasting 322 minutes, blood loss
was 150 ml, hospital stay was 13 days, there were
no complications observed. Final histology showed
invasive urothelial carcinoma pT2b grade 3 (high
grade), 10 lymphatic nodes without metastases
and prostate without malignancy. Patient lived
6 month after procedure without recurrence of
carcinoma, with normal renal function and normal
ultrasound findings of upper urinary tract.
Conclusion
: Laparoscopic radical cystectomy
is a safe method of treatment for invasive urothelial
bladder cancer.
KEY WORDS
Laparoscopic radical cystectomy, extracorporeal
ileal conduit, extensive pelvic lymphadenectomy.
LITERATURA
1. Witjes JA, Compérat E, Cowan NC, et al.
EAU guidelines on muscle-invasive and metastatic bladder
cancer: summary of the 2013 guidelines. Eur Urol. 2014; 65: 778–792.