CU 31. Laparoscopic radical cystectomy and urinary diversion: The experience of a single surgeon

Introduction: To introduce the experience of laparoscopic radical cystectomy (LRC) and urinary diversion of a single surgeon.

Methods: 33 cases of muscle-invasive bladder cancer underwent LRC and standard lymphadenectomy followed by minilaparostomy urinary diversion, including 13 cases of orthotopic T-pouch ileal neobladder, 10 cases of orthotopic Studer ileal neobladder, 2 cases of orthotopic Sigmoid neobladder and 8 cases of bricker conduit. Functional and oncological results were analyzed.

Results: Mean procedure time was 6.2 (4-8) hrs, blood loss 451 (100-1000) mL, transfusion 275 (0-800) mL, lymph nodes dissected 13.3 (5-23) and positive lymph nodes was found in 1 case, no positive margin was found, no peri-operative death. Perioperative complications were found in 15.1% (5/33) including 2 leaks at neobladder-urethra junction managed by drainage, 1 leak at ureter-neobladder junction which was repaired, 1 colon fistula treated by colostomy, 1 pelvic infection cured by drainage. In 45 days post-operative, Temporary dilation of upper urinary tract (UUT) was observed in 18.1% (6/33) and disappeared spontaneously in 3 months; temporarily increased serum creatinine in 2 cases and went back to base level in 3 months. Slight dilation of UUT was found in 6% (2/33) in late follow up, while serum creatinine remained in normal range in all patients.

Conclusions: LRC with standard lymphadenectomy and urinary diversion by mini-laparostomy is an acceptable minimally invasive procedure. The oncological and functional results are encouraging. Long term follow up is needed to verify the advantage of LRC compared with traditional open radical cystectomy and urinary diversion.