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Review
. 2012 Mar;10(1):40-5.
doi: 10.1016/j.aju.2012.01.003. Epub 2012 Feb 20.

Laparoscopic radical cystectomy

Amr Fergany  1
Affiliations
Review

Laparoscopic radical cystectomy

Amr Fergany. Arab J Urol. 2012 Mar.

Abstract

Objective: Laparoscopic radical cystectomy (LRC) has emerged as a minimally invasive alternative to open radical cystectomy (ORC). This review focuses on patient selection criteria, technical aspects and postoperative outcomes of LRC.

Methods: Material for the review was obtained by a PubMed search over the last 10 years, using the keywords 'laparoscopic radical cystectomy' and 'laparoscopic bladder cancer' in human subjects.

Results: Twenty-two publications selected for relevance and content were used for this review from the total search yield. The level of evidence was IIb and III. LRC results in comparable short- and intermediate-range oncological outcomes to ORC, with generally longer operative times but decreased blood loss, postoperative pain and hospital stay. Overall operative and postoperative morbidity are equivalent.

Conclusion: In experienced hands, LRC is an acceptable minimally invasive alternative to ORC in selected patients, with the main advantage of decreased blood loss and postoperative pain, as well as a shorter hospital stay and recovery.

Keywords: (O)(L)RC, (open) (laparoscopic) radical cystectomy; Bladder cancer; LND, lymph node dissection; Laparoscopy; Outcomes; Radical cystectomy.

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Figures

Figure 1
Figure 1
Port arrangement for LRC. A fifth port can be added in the left lower quadrant if needed. The camera port (B) can be moved to a supra-umbilical location to facilitate the proximal portion of an extended LND.
Figure 2
Figure 2
Lateral view showing the progression of dissection between the prostate and rectum. Denonvilliers’ fascia is encountered as a distinct layer that needs to be divided sharply.
Figure 3
Figure 3
As related to the ureters, the bladder pedicles form a lateral vascular portion (shown divided on the left side), and a posterior portion containing fewer blood vessels and more nerve fibres. In this diagram, both ureters have been divided.
Figure 4
Figure 4
Bladder mobilisation from the undersurface of the anterior abdominal wall.
Figure 5
Figure 5
Division of the dorsal vein complex.
See this image and copyright information in PMC

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