+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Perioperative outcomes with laparoscopic radical cystectomy: "pure laparoscopic" and "open-assisted laparoscopic" approaches

Perioperative outcomes with laparoscopic radical cystectomy: "pure laparoscopic" and "open-assisted laparoscopic" approaches

Urology 70(5): 910-915

Techniques for laparoscopic radical cystectomy are rapidly evolving. The entire procedure can be performed completely intracorporeally by pure laparoscopic techniques or by open-assisted laparoscopic techniques in which the urinary diversion is constructed extracorporeally by way of a minilaparotomy incision. We retrospectively evaluated the outcomes of these two techniques with a focus on perioperative outcomes and associated morbidity. From December 1999 to March 2006, 54 patients underwent laparoscopic radical cystectomy for muscle invasive (n = 35) or high-risk non-muscle-invasive (n = 19) bladder cancer. The mean follow-up was 25 months (range, 1 to 66 months). Of the 54 patients, 17 underwent a pure laparoscopic (group 1, 8 conduit and 9 neobladder) and 37 underwent an open-assisted laparoscopic (group 2, 18 conduit and 19 neobladder) procedure. No significant differences were noted between the groups in patient age, comorbidities, or pathologic stage of malignancy. Group 2 was superior with regard to operative time, blood loss, transfusion rate, time to oral intake, time to ambulation, and postoperative complications (P <0.05 for all comparisons). Anastomotic leak, bowel obstruction, or sepsis requiring reexploration developed in 5 patients (29%) in group 1 and 4 patients (11%) in group 2. A "learning curve" was observed for both procedures, but it was particularly steep for the pure laparoscopic technique, and this approach was eventually abandoned. Laparoscopic radical cystectomy is associated with a learning curve, with morbidity largely resulting from the urinary diversion procedure. Our experience suggests that the open-assisted laparoscopic approach is technically more efficient and associated with a quicker recovery profile and decreased complication rates compared with the pure laparoscopic approach.

(PDF emailed within 0-6 h: $19.90)

Accession: 021538558

Download citation: RISBibTeXText

PMID: 18068447

DOI: 10.1016/j.urology.2007.07.012

Related references

Robot-assisted laparoscopic radical cystectomy is a safe and effective procedure for patients with bladder cancer compared to laparoscopic and open surgery: Perioperative outcomes of a single-center experience. Asian Journal of Surgery 2017, 2017

Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy. Actas Urologicas Espanolas 41(7): 416-425, 2016

Robot-assisted laparoscopic vs open radical cystectomy: comparison of complications and perioperative oncological outcomes in 200 patients. Bju International 112(4): E290-E294, 2013

Oncological Outcomes in Patients Treated with Radical Cystectomy for Bladder Cancer: Comparison Between Open, Laparoscopic, and Robot-Assisted Approaches. Journal of Endourology 30(7): 783-791, 2017

Randomized Trial Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: Oncologic Outcomes. European Urology 74(4): 465-471, 2018

Multicentric comparison of surgical outcomes obtained after open radical cystectomy and robot-assisted laparoscopic radical cystectomy for muscle-invasive bladder cancer. European Urology Supplements 17(2): E1027-E1028, 2018

Comparative analysis of outcomes and costs following open radical cystectomy versus robot-assisted laparoscopic radical cystectomy: results from the US Nationwide Inpatient Sample. European Urology 61(6): 1239-1244, 2012

Comparison of outcomes between pure laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes. Bju International 109(6): 898-905, 2012

Pure laparoscopic versus robotic-assisted laparoscopic radical prostatectomy: comparative study to assess functional urinary outcomes. Progres en Urologie 19(9): 611-617, 2009

Nerve-sparing procedure in radical prostatectomy: a risk factor for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic procedures. Scandinavian Journal of Urology and Nephrology 45(3): 164-170, 2011

Robot-assisted laparoscopic management of duplex renal anomaly: Comparison of surgical outcomes to traditional pure laparoscopic and open surgery. Journal of Pediatric Urology 12(1): 44.E1-7, 2016

What about conventional laparoscopic radical cystectomy? Cost-analysis of open versus laparoscopic radical cystectomy. Journal of Endourology 28(4): 410-415, 2014

Open, laparoscopic and robot-assisted laparoscopic radical prostatectomy: comparative analysis of operative and pathologic outcomes for three techniques with a single surgeon's experience. European Review for Medical and Pharmacological Sciences 19(4): 525-531, 2015

The Association of Robot-assisted Versus Pure Laparoscopic Radical Nephrectomy with Perioperative Outcomes and Hospital Costs. European Urology Focus 2018, 2018

Robot-assisted radical hysterectomy—perioperative and survival outcomes in patients with cervical cancer compared to laparoscopic and open radical surgery. Gynecological Surgery 9(1): 81-88, 2012