Laparoscopic augmentation cystoplasty. Surgical technique.
Laparoscopic enterocystoplasty is technically feasible and successfully emulates the established principles of open enterocystoplasty while minimizing operative morbidity. As is true in open surgery, various bowel segments can be fashioned and anastomosed to the bladder laparoscopically. The increased costs associated with laparoscopy and with minimally invasive surgery in general have been a significant disadvantage; however, a previous report on the costs of laparoscopic procedures concluded that increased surgical experience reduces the surgical time and length of hospital stay, thereby decreasing costs. Furthermore, the increased use of reusable instruments results in considerable economic benefits. Implementation of appropriate cost-saving strategies ultimately will result in decreased expenses associated with laparoscopy. Although laparoscopic enterocystoplasty is currently a lengthy procedure lasting twice as long as open surgery, further technical modifications and increasing experience will continue to reduce the surgical time involved. For patients with complex comorbid illness who desire the improved quality of life associated with traditional augmentation cystoplasty, the reduced morbidity observed in the authors' series of patients undergoing a laparoscopic procedure makes this approach an attractive option to consider. The authors' initial experience suggests that laparoscopic enterocystoplasty has the potential to become a viable alternative to open enterocystoplasty.
Rackley
R R
RR
Section of Voiding Dysfunction and Female Urology, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. rackler@ccf.org
Abdelmalak
J B
JB
D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy; D018579:Patient Selection; D011182:Postoperative Care; D011300:Preoperative Care; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods