Mini-laparotomy approach to radical cystectomy

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? In the recent decade minimally invasive endoscopically approaches have been suggested as a way to reduce morbidity following radical cystectomy. The present study suggests that the same advantages found, when comparing endoscopical cystectomy to classical open cystectomy, can be achieved by reducing the wound length of the open approach.

OBJECTIVE

• ? To investigate the feasibility of performing radical cystectomy (RC) through a mini‐laparotomy and to evaluate the effect of a smaller incision on wound problems, immediate postoperative pain, bowel function and length of hospital stay (LOS).

PATIENTS AND METHODS

• ? Two consecutive cohorts of patients, one with 75 patients undergoing open RC (ORC) with lymph node dissection up to the aortic bifurcation through a conventional long midline incision and one with 75 patients undergoing RC through a mini‐laparotomy (MinilapRC) of intentionally <8–10 cm.
• ? Patient characteristics, operative duration, estimated blood loss (EBL), incidence and severity of wound problems, return of bowel function, amount of analgesics needed and LOS were analysed according to the intention‐to‐treat principle.

RESULTS

• ? The demographic characteristics of the two groups were similar.
• ? An incision of ≤10 cm was made in 65% of the patients in the MinilapRC group with a median (range) length of incision of 9 (6.5–19) cm. In the final third of patients operated on in the MinilapRC group, 76% had an incision of ≤8 cm.
• ? The operative duration and EBL were not significantly different between the groups.
• ? Wound problems were significantly fewer, bowel function was restored more quickly and the need of postoperative analgesics was less in the MinilapRC group.
• ? In the MinilapRC group LOS was reduced by a median of 3 days.

CONCLUSION

• ? MinilapRC is feasible in most patients without increasing operative duration. The reduced incision length reduces postoperative morbidity.