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Owyong M, Koru-Sengul T, Miao F, Razdan S, Moore KJ, Alameddine M, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy. Urol Oncol 2019; 37:870-876. [PMID: 31445895 PMCID: PMC7696003 DOI: 10.1016/j.urolonc.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/15/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort. MATERIALS AND METHODS Patients who underwent partial cystectomy from 2010 to 2014 were identified in the National Cancer Data Base. The primary outcome was surgical margin status. A multivariable logistic regression model was fitted to identify patient, hospital, and surgical factors associated with positive surgical margins (PSMs). RESULTS Partial cystectomy was performed in 1,118 patients via open (n = 715, 64%), laparoscopic (n = 209, 19%), and robotic (n = 194, 17%) approaches. Overall, 220 (19.7%) patients had PSMs. The PSM rate by surgical approach was 19.6% for open, 18.2% for laparoscopic, and 21.6% for robotic (P = 0.678). Compared to open partial cystectomy, the laparoscopic (aOR 1.06, 95%CI 0.70-1.60, P = 0.782), and robotic (aOR 1.28, 95%CI 0.85-1.91, P = 0.235) approaches were not significantly different in terms of PSM rate. There were higher odds of PSMs in non-Hispanic blacks (aOR 1.93, 95%CI 1.09-3.39, P = 0.023) compared to non-Hispanic whites, and in patients with muscle invasive bladder cancer (aOR 3.28, 95%CI 2.00-5.37, P < 0.001) or tumor size ≥ 3 cm (aOR 1.67, 95%CI 1.21-2.30, P = 0.002). Tumors in a dome/urachal location had lower odds of a PSM compared to tumors in a nondome/urachal location (aOR 0.67, 95%CI 0.47-0.94, P = 0.022). CONCLUSIONS Our results suggest that partial cystectomy using a laparoscopic or robotic-assisted approach is not associated with an increased risk of PSMs compared to open partial cystectomy.
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Affiliation(s)
- Michael Owyong
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Shirin Razdan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
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Sood A, Klett DE, Abdollah F, Sammon JD, Pucheril D, Menon M, Jeong W, Peabody JO. Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique. Investig Clin Urol 2016; 57:221-8. [PMID: 27195322 PMCID: PMC4869563 DOI: 10.4111/icu.2016.57.3.221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/16/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Dane E Klett
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Dan Pucheril
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
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Umbilical laparoendoscopic partial cystectomy. Actas Urol Esp 2015; 39:451-5. [PMID: 25749459 DOI: 10.1016/j.acuro.2014.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To present our center's experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics, perioperative aspects and the surgical techniques used are reviewed. MATERIAL AND METHOD Since May 2012, five patients have undergone a transumbilical single-port laparoendoscopic partial cystectomy with curved equipment through a reusable multichannel system and a 3.5mm accessory trocar. Patients were three males and two females aged between 28 and 78 (median: 44±42.5) years. The etiologies were endometriosis (in 2 cases), a tumor in the diverticulum, a congenital bladder diverticulum and ureterocele (1 case of each). RESULTS Median surgery time was 273±163.4minutes, and intraoperative bleeding 250±175ml. None of the patients required transfusion. The postoperative period was uneventful, with good results and no complications. The hospital stay was 3±1 days. With monitoring of 20±17.5 months, morphological and functional recovery in the bladder and ureter was confirmed in all cases and the patient with neoplastic disease was disease-free more than 2 years after the surgery. CONCLUSIONS An umbilical laparoendoscopic partial cystectomy represents a viable surgical option and ensures that excellent surgical and cosmetic results are achieved.
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Haddad A, Lotan Y, Sagalowsky AI. Partial cystectomy. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lei Y, Tong S, Zu X, Li Y, He W, Hu X, Liu W, Wang Z, Qi L, Chen M. Extraperitoneal and transperitoneal laparoscopic partial cystectomy for benign non-urothelial bladder tumors: an initial experience. Urol Int 2014; 94:149-55. [PMID: 25359449 DOI: 10.1159/000366067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study presents our initial experience with extraperitoneal and transperitoneal laparoscopic partial cystectomy (LPC) in the treatment of benign non-urothelial bladder tumors. METHODS Eleven patients with benign non-urothelial bladder tumors underwent extraperitoneal or transperitoneal LPC. The five cases with tumors located on the anterior/anterolateral bladder wall received the extraperitoneal approach. The six cases with tumors located around the bladder dome or over the posterior bladder wall received the transperitoneal approach. Key perioperative parameters were recorded. RESULTS All patients underwent laparoscopic resection smoothly without requiring a conversion to a traditional open procedure, and no patient displayed perioperative complications. Pathology showed benign non-urothelial bladder tumors with normal margins in all eleven patients, including five leiomyoma cases, three pheochromocytoma cases, two paraganglioma cases and one inflammatory fibrous histiocytoma case. Follow-up cystoscopy and imaging studies in all eleven patients (mean follow-up period 32 months) revealed neither residual nor local recurrence. CONCLUSIONS LPC is safe and feasible in select patients with benign non-urothelial bladder tumors and yields satisfactory oncological and functional results. Extraperitoneal LPC should be preferred for lesions located on the anterior/anterolateral bladder wall, while transperitoneal LPC should be preferred for lesions around the bladder dome or over the posterior bladder wall.
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Affiliation(s)
- Ye Lei
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Kim BK, Song MH, Yang HJ, Kim DS, Lee NK, Jeon YS. Use of cystoscopic tattooing in laparoscopic partial cystectomy. Korean J Urol 2012; 53:401-4. [PMID: 22741048 PMCID: PMC3382689 DOI: 10.4111/kju.2012.53.6.401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/04/2012] [Indexed: 12/16/2022] Open
Abstract
Purpose During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. Materials and Methods LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. Results All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. Conclusions Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.
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Affiliation(s)
- Bong Ki Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Laparoscopic radical cystectomy for bladder cancer with prostatic and neurovascular sparing: initial experience. Int Urol Nephrol 2012; 44:787-92. [DOI: 10.1007/s11255-011-0121-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
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Challacombe BJ, Rose K, Dasgupta P. Laparoscopic radical and partial cystectomy. J Minim Access Surg 2011; 1:188-95. [PMID: 21206662 PMCID: PMC3004121 DOI: 10.4103/0972-9941.19266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 12/12/2005] [Indexed: 11/17/2022] Open
Abstract
Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy.
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Allaparthi S, Ramanathan R, Balaji KC. Robotic partial cystectomy for bladder cancer: a single-institutional pilot study. J Endourol 2010; 24:223-7. [PMID: 20039797 DOI: 10.1089/end.2009.0367] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Open partial cystectomy has been used as a curative option for select group of patients with bladder cancer. In recent years, the da Vinci Surgical Robotic System is being increasingly used to perform complex urologic cancer surgeries. We report first on a consecutive cohort of patients undergoing robotic partial cystectomy (RPC) for bladder cancer. METHODS Three consecutive patients underwent RPC, two with diagnosis of papillary neoplasm of bladder and one with urachal adenocarcinoma at our institution from July 2008 to January 2009. Perioperative parameters were prospectively collected and analyzed after Institutional Review Board approval. RESULTS All three patients in the study were men with a median age of 50 years (range, 24-70 years). The RPC was completed transperitoneally in all three patients without the need for open conversion. The operative time, estimated blood loss, and time to hospital discharge for the three patients undergoing RPC were 185, 135, and 165 minutes; 25, 20, and 20 mL; and 5, 2, and 2 days, respectively. The percentage change in hematocrit after surgery was within 5% in all patients. There were no postoperative complications before discharge; however, one patient was readmitted and underwent small bowel resection secondary to bowel obstruction. Final pathology demonstrated high-grade carcinoma pT2bNxMx and pTaNxMx papillary urothelial carcinoma in two patients and invasive adenocarcinoma of the bladder pT3aNxMx in the remaining patient. The median follow-up was 6 months (range, 3-10 months). All three patients were alive with no signs of recurrent or metastatic disease on cystoscopic, cytological, or radiological follow-up. CONCLUSIONS RPC is technically feasible using the da Vinci Surgical Robotic System in select patients with bladder cancer without disease recurrence in the short term. A larger cohort with long-term follow-up is necessary to validate our results.
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Affiliation(s)
- Satya Allaparthi
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
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10
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Colombo JR, Desai M, Canes D, Frota R, Haber GP, Moinzadeh A, Tuerk I, Desai MR, Gill IS. Laparoscopic partial cystectomy for urachal and bladder cancer. Clinics (Sao Paulo) 2008; 63:731-4. [PMID: 19060992 PMCID: PMC2664270 DOI: 10.1590/s1807-59322008000600004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 08/11/2008] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy. MATERIALS AND METHODS Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation. RESULTS All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation. CONCLUSIONS Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.
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Affiliation(s)
- Jose R Colombo
- Section of Laparoscopic and Robotic Surgery, Cleveland Clinic, Glickman Urological Institute, Cleveland, Ohio, USA.
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Tareen BU, Mufarrij PW, Godoy G, Stifelman MD. Robot-assisted laparoscopic partial cystectomy and diverticulectomy: initial experience of four cases. J Endourol 2008; 22:1497-500. [PMID: 18690815 DOI: 10.1089/end.2007.0297] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We report our initial experience with four cases of robot-assisted laparoscopic partial cystectomy and diverticulectomy performed between June 2005 and August 2007. PATIENTS AND METHODS The series consisted of three male patients and one female with a mean age of 64 years (range 36-77 years). In each case, a transperitoneal laparoscopic approach was used to mobilize the bladder. Next the bladder lesion was scored circumferentially cystoscopically with a Collings knife. The remainder of the excision and bladder reconstruction was performed with the da Vinci robot. RESULTS Mean operative time was 194 minutes with a mean blood loss of 35 mL. The urethral catheter was removed between 5 and 14 days following a normal cystogram. There were no significant complications. Postoperative hospital stay was 2 to 3 days. CONCLUSION Robot-assisted laparoscopic partial cystectomy and diverticulectomy are technically feasible and represent an alternative to open and conventional laparoscopic approaches.
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Affiliation(s)
- Basir U Tareen
- Urologic Oncology Program, Department of Urology, New York University Medical Center, New York, New York 10016, USA
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Necrotic mass after transurethral resection of a bladder tumor: novel management with robotic partial cystectomy. J Robot Surg 2008; 1:257-61. [PMID: 25484974 PMCID: PMC4247438 DOI: 10.1007/s11701-007-0041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Accepted: 09/04/2007] [Indexed: 11/25/2022]
Abstract
A 76-year-old female with a history of high-grade transitional cell carcinoma (TCC) of the bladder presented with persistent nocturia and urge incontinence and was diagnosed with a necrotic bladder lesion. Cystoscopy revealed a 4 cm area of necrosis, ulceration, calcification, and fat. Transurethral biopsy confirmed the lesion to be benign, and two attempts to re-epithelialize the area of necrosis with cold scraping of exudate failed. Decision was then made to proceed with removal of necrotic lesion with bladder preservation. With the aid of concomitant cystoscopic visualization of the necrotic lesion, a robotic partial cystectomy with bladder reconstruction was performed. The patient tolerated the procedure, had an uneventful post-operative course, and remains asymptomatic and disease-free at last follow-up of 6 months. To our knowledge, this case represents the first report of a necrotic lesion as a complication of transurethral resection of a bladder tumor (TURBT) and the first description of a robotic partial cystectomy for the management of either benign or malignant bladder disease.
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Wang CK, Chueh SC. Case Report: Laparoscopic Partial Cystectomy with Endo-GIA Stapling Device in Bladder Diverticular Carcinoma. J Endourol 2007; 21:772-5. [PMID: 17705769 DOI: 10.1089/end.2006.0348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The incidence of bladder diverticular carcinoma is low, ranging from 0.8% to 10%. Traditionally, treatment consisted of open surgical excision or transurethral resection. More recently, laparoscopic surgery has become widely accepted. We report here a case of bladder diverticular carcinoma treated with laparoscopic partial cystectomy. CASE REPORT A 56-year-old man presented with gross hematuria and was found to have transitional-cell carcinoma in a bladder diverticulum. We performed transurethral resection of the tumors and laparoscopic partial cystectomy. A 45-mm Endo-GIA stapler (U.S. Surgical Corp., Norwalk, CT) was used for direct resection of the diverticular tissue, and the specimen was removed en bloc. Suture of the seromuscular layer was performed with the intracorporeal knotting technique. Lymph-node dissection also was performed. At 3-month follow-up, it was noted that there was tumor recurrence that was not at the original diverticular site, and transurethral resection was carried out. After 1 year, cystoscopy and CT scans showed neither recurrence nor metastasis. No encrustation or erosion was induced by the staples. CONCLUSION Laparoscopic partial cystectomy can be an alternative treatment for bladder diverticular carcinoma.
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Affiliation(s)
- Chun-Kai Wang
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Abstract
OBJECTIVE To present our initial experience with laparoscopic partial cystectomy (LPC) in selected patients with various bladder pathologies. PATIENTS AND METHODS Between December 2004 and April 2006, four patients had LPC at our centre (mean age 52 years, range 35-70); the transperitoneal approach was used for three and a pre-peritoneal approach for one. The surgical procedures used sequentially included transurethral incision around the lesion, laparoscopic excision of the lesion (partial cystectomy) and intracorporeal suturing. Laparoscopic pelvic lymphadenectomy was also used for the two patients with malignancy. RESULTS All operations proceeded smoothly; the bladder pathologies included one bladder endometriosis, one bladder leiomyoma, one urothelial carcinoma within the bladder diverticulum and one urachal adenocarcinoma. The mean (range) operative duration was 197.5 (120-300) min, the estimated blood loss 70 (50-100) mL, the hospital stay 6.75 (5-9) days, and duration of Foley catheterization 7.25 (6-9) days. No open conversion was required and no patient had peri-operative complications. The surgical margins were free of cancer and the dissected lymph nodes were negative in those two patients with bladder malignancy. CONCLUSIONS LPC is safe and feasible in selected patients with various bladder pathologies.
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Affiliation(s)
- Huai-Ching Tai
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Kim BH, Kim JH, Park WJ, Ryu DS, Kwon JO, Oh TH. Laparoscopic Partial Cystectomy for Adenocarcinoma of the Bladder. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.9.990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Byung Hwan Kim
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Jae Ho Kim
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Woo Jin Park
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Dong Soo Ryu
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Jun O Kwon
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Tae Hee Oh
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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Abstract
Laparoscopic urology has evolved considerably during last decade as well as number and spectrum of surgical related complications. Experiences reported by laparoscopic trained groups allow preventing, promptly recognizing, and safe and efficient management of the laparoscopic related complications. We present our complications in all patients undergoing urological laparoscopic procedures from November 1992 to June 2005. A literature search was conduced to evaluate complications of every laparoscopic procedure.
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Affiliation(s)
- O Castillo
- Unidad de Endourología y Laparoscopia Urológica, Clínica Santa María.
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Wadhwa P, Kolla SB, Hemal AK. Laparoscopic en bloc partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Urology 2006; 67:837-43. [PMID: 16618570 DOI: 10.1016/j.urology.2005.10.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 09/28/2005] [Accepted: 10/26/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgical options for treating urachal adenocarcinoma include radical cystectomy and en bloc partial cystectomy with excision of the urachus and umbilectomy. Recently, laparoscopy has been increasingly used to treat bladder and urachal pathologic findings efficaciously. We describe two techniques for performing laparoscopic en bloc partial cystectomy with bilateral extended pelvic lymphadenectomy. TECHNICAL CONSIDERATIONS We performed the procedure in 3 patients with established urachal adenocarcinoma. The anatomic boundaries of resection were similar to those described for open surgery. We used an inverted V-shaped, five-port configuration, with the camera port placed 3 cm supraumbilically. An antegrade approach was performed for tumors less than 5 cm in 2 cases. The steps of the procedure included an inverted V-shaped incision along the peritoneum lateral to the medial umbilical ligament on either side; urachal disconnection, dissection of the urachus using the "twist and roll technique"; anterior cystotomy, circumferential resection of the tumor-bearing bladder dome, under vision; tumor placement in a "lap-bag"; bladder reconstruction using intracorporeal suturing; bilateral extended pelvic lymphadenectomy; placement of catheter and drain; and specimen retrieval. We evolved a retrograde technique for larger size tumors (larger than 5 cm). The procedure was successfully completed in all patients, with a mean operative time of 180 minutes (range 150 to 210). No significant intraoperative or postoperative complications occurred, except for a left inferior epigastric artery injury in 1 case. The resected nodes (range 8 to 11) were free of tumor. No local or distant recurrences were observed at a mean follow-up of 6.5 months (range 4.5 to 9). CONCLUSIONS Laparoscopic en bloc partial cystectomy and bilateral extended pelvic lymphadenectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for urachal tumors.
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Affiliation(s)
- Pankaj Wadhwa
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Abreu SC, Silveira RA, Cerqueira JB, Regadas RP, Gonzaga LF, Fonseca GN. Stapleless laparoscopic assisted radical cystectomy with ileal neobladder in a male and with ileal loop in a female: initial report from Brazil. Int Braz J Urol 2005; 31:214-20. [PMID: 15992423 DOI: 10.1590/s1677-55382005000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 03/19/2005] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Here, we report our initial experience with laparoscopic assisted radical cystectomy without the use of surgical staples. CASES REPORT A 70 year old male and a 55 year old female were diagnosed to have T2G3 transitional cell carcinoma of the bladder with negative metastatic work-out. Both patients were scheduled and agreed to a laparoscopic assisted radical cystectomy. In both cases, urinary diversion (orthotopic ileal Studer neobladder in the male and ileal conduit in the female) was performed extracorporeally following radical cystectomy. In both cases control of the bladder vascular pedicle was accomplished with a combination of metallic and hem-o-lock clips. The total surgical time was 6.5 hours in both cases. Estimated intra-operative blood loss was 500 cc and 350 cc respectively, however both patients required postoperative blood transfusions. No intraoperative complications occurred. In both cases, pathology revealed negative surgical margins. CONCLUSIONS Extracorporeal creation of urinary diversion decrease the overall operative time. Laparoscopic pelvic lymphadenectomy can be performed following the extended template. The use of surgical clips instead of vascular Endo-GIA titanium staples to control the bladder vascular pedicles is feasible and safe in selected patients, thus reducing intraoperative surgical costs. Considerable experience with laparoscopic radical prostatectomy is necessary before one attempts laparoscopic radical cystectomy.
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Affiliation(s)
- Sidney C Abreu
- Sections of Urology, Federal University of Ceara and Federal University of Goias, Brazil.
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