Laparoscopic radical cystectomy and ileal conduit reconstruction: preliminary experience

PURPOSE: We present our preliminary experience with laparoscopic radical cystoprostatectomy for muscle-invasive carcinoma of the urinary bladder. Patient and operative data and the surgical technique are presented. PATIENTS AND METHODS: Laparoscopic radical cystoprostatectomy and bilateral pelvic lymph node dissection were performed using five or six ports by a transperitoneal approach. An ileal conduit urinary diversion was constructed at the site of specimen retrieval. RESULTS: The procedure was successful in nine of ten patients with a mean blood loss of 533 mL and an average transfusion of 1.3 units per patient. The mean operating time was 6.48 hours and an average of 33 mg of morphine equivalents was required for analgesia. The mean hospital stay was 10.8 days. One patient had surgical margins positive for cancer, while none had histologic evidence of pelvic nodal metastasis. There were five minor and major intraoperative and postoperative complications. The remaining patient, treated early in our experience, developed hypercarbia necessitating conversion to open surgery. No metastases have been seen after a mean duration of follow-up of 19 months. CONCLUSIONS: Laparoscopic radical cystoprostatectomy with open ileal conduit urinary diversion is a feasible alternative to traditional open radical cystectomy. Urinary diversion can be performed through the small incision necessary to extract the surgical (radical cystoprostatectomy) specimen from the abdomen. With our modified technique, it also is feasible to reduce the cost.