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Laparoscopic radical cystectomy. The new gold standard for bladder carcinoma?
Octavio A. Castillo, Gonzalo Vitagliano and Ivar Vidal-Mora.

JOURNAL
Tomo 62. Número 09 - Noviembre 2009

REFERENCE
Arch. Esp. Urol. 2009; 62 (9): 737-744

KEYWORDS
Bladder cancer. Radical cystectomy and laparoscopy.

OBJECTIVES
The experience of a renowned Latin American laparoscopic center is reported and the differences with the open technique are thoroughly discussed.

METHODS
During a 7 year period a total of 85 laparoscopic cystectomies were performed; in 92% of the cases urinary diversion was performed extracorporeally. This accounted for: 14 anterior exanterations, 50 radical cystoprostatectomies, 7 radical cystectomies and 14 simple cystectomies. Male to female ratio was 3:1. Mean patient age was 63 years (range 29 to 83). Mean Body Mass Index (BMI) was 28 kg/m2 (range 20 to 47). Operative data and long term results are analyzed.

RESULTS
All 85 procedures were completed laparoscopically without need for conversion to open surgery. Orthotopic neobladder, Santiago pouch, Studer, Fontana and Le Bag were performed in 42, 13, 16, 12 and 1 case respectively. Ileal conduit, Indiana pouch and Mainz II were employed in 24, 10 and 9 cases respectively. All Mainz II were performed intracorporeally. Mean operative time and blood loss were 279 minutes (range 180 to 375) and 436 ml (range 50 to 1.500) respectively. A total of 8 patients (11%) presented perioperative complications: 5 vascular lesions, 2 eviscerations and 2 septicemias. Delayed complications were observed in 7 cases (9%); 3 urinary sepsis, 1 ureteral stenosis, 2 spontaneous ruptures and 1 mesenteric ischemia. Mean hospital stay was 8.8 days (range de 4 to 28). There was no operative mortality. Mean follow-up was 18 months (range 2 to 68 months). Ten patients (13%) presented disease progression and death.

CONCLUSIONS
Laparoscopic radical cystectomy is associated with diminished operative bleeding, time to oral intake and hospital stay. Though this is a reproducible technique it demands a very long learning curve.




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