1
|
Rassweiler J, Godin K, Goezen AS, Kusche D, Chlosta P, Gaboardi F, Abbou CC, van Velthoven R. [Radical cystectomy - pro laparoscopic]. Urologe A 2012; 51:671-8. [PMID: 22532364 DOI: 10.1007/s00120-012-2863-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the technical feasibility of laparoscopic radical cystectomy (LRC) has been proven and the procedure has been accepted in the EAU guidelines 2011 as a valid alternative, its actual position has to be determined. On the one hand the advantages of LRC (less blood loss, lower transfusion rates, shorter analgesia time) have been proven in retrospective studies; however, the technical difficulties of purely laparoscopic urinary diversion result in very long operating times and in cases of a laparoscopic-assisted creation of a neobladder, the question of the advantage of this approach remains doubtful. Despite case reports of port metastases and peritoneal carcinosis following laparoscopic and robot-assisted radical cystectomy, there is no difference in terms of oncological long-term data (up to 10 years) between laparoscopy and open surgery performed at centres of excellence. Evidently, the curative options for the patients do not depend on the type of surgery (open versus minimally invasive) but on the efficacy of adjuvant treatment strategies (polychemotherapy). Currently it is believed that LRC should be considered for patients with low risk of progression (pT1-2). The final position of laparoscopic radical cystectomy can only be evaluated in a multicentric randomized controlled trial.
Collapse
Affiliation(s)
- J Rassweiler
- Urologische Klinik Klinkum Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg, Am Gesundbrunnen 20, 74074 Heilbronn, Deutschland.
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Huang J, Lin T, Xu K, Huang H, Jiang C, Han J, Yao Y, Guo Z, Xie W, Yin X, Zhang C. Laparoscopic Radical Cystectomy with Orthotopic Ileal Neobladder: A Report of 85 Cases. J Endourol 2008; 22:939-46. [PMID: 18419330 DOI: 10.1089/end.2007.0298] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jian Huang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianxin Lin
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kewei Xu
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Huang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun Jiang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinli Han
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yousheng Yao
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenghui Guo
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenlian Xie
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinbao Yin
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Caixia Zhang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
3
|
Rassweiler J, Teber D, de la Rosette J, Laguna P, Pansodoro V, Frede T. Laparoskopische Beckenchirurgie. Urologe A 2006; 45:1135-6, 1138-44. [PMID: 16900368 DOI: 10.1007/s00120-006-1151-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laparoscopic radical prostatectomy has become an equivalent alternative to the open retropubic approach, offering the advantages of minimally invasive surgery. It is being applied increasingly in Germany and the rest of Europe. Whether the surgical robot da Vinci will be used for this procedure to the same extent as in the United States is unpredictable because of high investment and maintenance costs. Similarly, laparoscopic sacrocolpopexy has proven to be a viable option compared to open transabdominal or transvaginal surgery, showing a significant reduction in postoperative morbidity. The value of radical cystectomy is controversial despite proven feasability. On one hand, the technical difficulties of purely laparoscopic urinary diversion result in very long operating times, and in the case of the laparoscopically assisted creation of a neobladder, the advantage of this approach has to be questioned. On the other hand, a maximum rate of 30% of local recurrences and distant metastases indicates at least poor patient selection. In conclusion, this procedure should be limited to a few experienced centers.
Collapse
Affiliation(s)
- J Rassweiler
- Urologische Klinik, SLK-Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg, Am Gesundbrunnen 20, 74074, Heilbronn.
| | | | | | | | | | | |
Collapse
|
4
|
Abstract
The introduction of laparoscopic pyeloplasty was the first step towards the development of suturing and knotting techniques. The final breakthrough came with the development of radical prostatectomy since the performance of the urethrovesical anastomosis required highly developed skills in reconstructive surgery. For most laparoscopic surgeons suturing and knot tying became quite familiar henceforth. As a consequence, the interest for other reconstructive procedures has increased tremendously since. Within a very short time pyeloplasty was developed to a surgical standard, and the results compare very favorably with open surgery. A very attractive method is the ureteral reimplantation according to the psoas hitch technique, which, however, does not completely duplicate the open surgical operation. Many patients can potentially be attracted by sacrocolpopexy to treat genital prolapse. The long-term success rate is 92% which is excellent for this indication. Urinary diversion following cystectomy is usually not performed completely intracorporeally, but laparoscopically assisted.
Collapse
Affiliation(s)
- G Janetschek
- Abteilung für Urologie, Krankenhaus der Elisabethinen, Fadingerstrasse 1, A-4010, Linz, Osterreich.
| |
Collapse
|