Laparoscopic Partial Cystectomy in Different Scenarios: Our Experience

Abstract

Introduction:

Radical cystectomy is considered the standard of care approach for definite management of vesical neoplasms. Although oncologically justifiable, this procedure is attended with significant morbidity, most notable being altered voiding and sexual functions of the sufferer. ¹ Selected neoplasms in patients desirous of bladder preservation have been dealt by partial cystectomy. ² Partial cystectomy has been attempted through incisional, laparoscopic, or robotic approaches. ^3,4 We demonstrate our technique of laparoscopic partial cystectomy.

Methods:

Patients were selected after detailed evaluation, including presenting complaints, clinical parameters, blood profile, and imaging (ultrasonography, computed tomography, or magnetic resonance urogram). Cystoscopy was performed with a lesional biopsy and an assessment of bladder capacity. Patients with a solitary lesion involving bladder dome where satisfactory extirpation with a reasonable vesical margin is achievable, good bladder capacity, no concomitant upper tract pathologies, and consenting to periodic surveillance were selected for this procedure. Patients were positioned in Trendelenberg decubitus with modified lithotomy to facilitate preoperative cystoscopy. In larger tumors, if proximity of resection margin to trigone was apprehended, bilateral ureteral stenting was undertaken. Four ports were utilized: 2–10-mm ports (one camera port and one working port) and 2–5-mm working ports. Tumor extent was defined by following the light emanated from the cystoscope. Tumor with a generous cuff of healthy vesical mucosa was disconnected from the main bladder. In urachal adenocarcinomas, the urachus was also excised in continuity with the lesion. The specimen was immediately entrapped in a retrieval bag. In patients without ureteral stents, urine efflux from ureteric orifices was confirmed. Vesical closure was achieved by intracoporeal suturing employing 3-0 polyglactin. Peritoneal toileting was conducted with copious tumoricidal irrigant. After drain placement, the specimen was extracted by extension of umbilical port, and all access sites were closed. Operative and postoperative events were recorded. Patients received adjuvant treatment based on specimen pathology. Postprocedure patients underwent 3-monthly evaluations (clinical, blood profile, and cystoscopy). Imaging was repeated at yearly intervals.

Results and Discussion:

Between January 2006 and December 2011, nine cases were performed successfully (eight adenocarcinomas and one colovesical fistula of benign etiology—patient underwent laparoscopic partial cystectomy, fistula excision, and laparoscopic establishment of bowel continuity). The mean age was 42.3 years. Six were men and three women. Presenting complaints were hematuria, frequency, and urgency. The mean operation duration was 190.12 minutes. The mean blood loss was 150 mL. The mean duration of hospital stay was 4.5 days. No major intraoperative or postoperative happenings were remarked. Till last follow-up, all patients were asymptomatic with preserved voiding and sexual functions and no evidence of disease recurrence. In selected scenarios, laparoscopic partial cystectomy offers a satisfactory oncological outcome with an appreciable morbidity profile.

No competing financial interests exist.

Runtime of video: 6 mins 20 secs