KMID : 1011820220630050523
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Investigative and Clinical Urology 2022 Volume.63 No. 5 p.523 ~ p.530
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Laparoscopic radical cystectomy with pelvic lymph node dissection and ileal orthotopic neobladder by a total extraperitoneal approach: Our initial technique and short-term outcomes
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Zhu Guanqun
Zhang Zongliang Zhao Kai Yin Xinbao Zhang Yulian Wang Zhenlin Li Chen Sui Yuanming Li Xueyu Yang Han Xing Nianzeng Wang Ke
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Abstract
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Purpose: With the increasing application of laparoscopic or robot-assisted radical cystectomy, a reliable and promising method is needed for reducing postoperative complications. We describe the short-term outcomes of totally extraperitoneal laparoscopic radical cystectomy (TELRC) with extraperitoneal pelvic lymph node dissection (EPLND) and extraperitoneal ileal orthotopic neobladder (EION) techniques.
Materials and Methods: From January 2020 to December 2021, we performed TELRC and EPLND with EION in 72 patients in our center. The accompanying video highlights our novel techniques. The patients¡¯ demographic data, intraoperative data, and perioperative complications were collected, and short-term oncological and functional results are reported.
Results: All procedures were technically successful without conversion to open surgery. The patients¡¯ mean body mass index was 26.22¡¾5.71. Median age was 57.51¡¾12.34 years. Average hospital stay was 13.78¡¾4.62 days. Median intraoperative blood loss was 112.92¡¾88.56 mL. No blood transfusion was needed during the operations and only one blood transfusion was performed during the perioperative period. Mean operating time was 259.44¡¾49.84 minutes. Average cost was US$9,875.71¡¾1,873.08. Postoperative short-term complications included short-term ileus (n=3), infection (n=13), leakage of urine (n=11), and lymph fistula (n=7). One late complication of unilateral vesicoureteral anastomotic stenosis occurred. The mean follow-up was 13.42¡¾8.77 months, and no patient developed local or systemic recurrence. The short-term follow-up and small cohort of patients limited our evaluation of outcomes.
Conclusions: TELRC with PLND and EION was technically feasible and clinically promising, with a reduced potential harm of postoperative complications. Long-term follow-up and a larger cohort of patients are needed for further study.
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KEYWORD
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Cystectomy, Laparoscopes, Urinary bladder neoplasms, Urinary diversions
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