Laparoscopic Partial Cystectomy Guided by Real-Time Cystoscopic Visualization

Abstract

Introduction:

Laparoscopic partial cystectomy is limited to solitary tumors in the bladder (bladder endometriosis, pheochromocytoma, leiomyoma, squamous cell, adenocarcinoma, and transitional cell carcinoma) where a sufficient margin is obtainable. The tumor should be distant both from the bladder neck and trigone, as well to allow adequate resected margin (1–2 cm).

Materials and Methods:

To demonstrate this technique, we present a case of a 69-year-old diabetes mellitus/hypertension/coronary artery disease male patient with a history of painless gross hematuria since 1 month, on evaluation found to have lobulated a 4 × 3 cm bladder mass lesion on the anterosuperior bladder wall. He initially underwent cystoscopy and biopsy, which showed well-differentiated adenocarcinoma infiltrating the lamina propria and muscularis propria. Hence, he was planned for laparoscopic partial cystectomy. The surgery was performed in a steep Trendelenburg position with standard four ports (two 12 mm and two 5 mm) being placed. Simultaneous cystoscopy and laparoscopy were done to score the proposed margins accurately. A real-time dual video feed on the same monitor was provided to assist the markings. Both direct visualization and transillumination were utilized for scoring. Resected specimen was immediately placed in the Nadiad bag and taken out through port incision.

Results:

Till date, we have performed four cases with this technique. The mean operative time was 155 ± 23.80 minutes, estimated mean blood loss was 55 ± 5.77 mL, and the mean hemoglobin drop was 0.22 g/dL. The time for oral diet was 1 day in all patients with a mean hospital stay of 3.5 ± 0.57 days. None of the patients required either blood transfusion or open conversion. The final histopathology report showed pT_2bN₀ (adenocarcinoma) in one patient, pT_2bN₀ (transitional cell carcinoma) in another, and pT_2aN₀ (transitional cell carcinoma) in the remaining two patients. Foleys was removed on the sixth post operative day in all patients after cystogram. There were no intraoperative or postoperative (3 months) complications.

Conclusion:

Simultaneous cystoscopic visualization during laparoscopic partial cystectomy is safe and facilitates dissection to achieve negative surgical margins without increasing any additional morbidity or operative time.

The authors declare that no competing financial interests exist.

Runtime of video: 6 mins 20 secs