Hand assisted laparoscopic cystectomy with minilaparotomy ileal conduit: series report and comparison with open cystectomy.
OBJECTIVE
To achieve less patient morbidity our initial experience with hand assisted laparoscopic (HAL) cystectomy was compared with our results of open cystectomy with similar urinary diversion.


METHODS
During 18 months 36 cystectomies were performed, including 20 with open continent diversion. A prospective, nonrandomized comparison of the remaining 16 consecutive cystectomies with ileal conduit diversion (hand assisted laparoscopic cystectomy and open cystectomy in 8 cases each) was performed. Of the 16 cystectomies 13 were performed for muscle invasive bladder cancer. Standard parameters were compared concerning patient operative and postoperative courses using statistical analysis with the 2-tailed t test. A novel surgical technique for completing these HAL procedures is described and compared to standard open cystectomy and ileal conduit diversion.


RESULTS
A total of 16 patients successfully underwent open (8) and HAL (8) cystectomy with an ileal conduit. Mean estimated blood loss in the HAL and open groups was 637 and 957 cc, respectively (p = 0.23). The mean postoperative parenteral analgesia administered was 31 mg in the HAL group vs 149 mg in the open group (p = 0.01). The HAL and open groups had a mean length of stay of 6.4 vs 9.8 days (p = 0.06). Mean operative time did not differ significantly between the HAL and open groups (403 and 420 minutes, respectively). Regular diet was resumed at 4.5 days in the HAL group vs 7.9 days in the open group (p = 0.05). Hospital length of stay was 6.4 vs 9 days for HAL vs open cases (p = 0.06).


CONCLUSIONS
To our knowledge this represents the first reported series of patients undergoing HAL cystectomy with urinary diversion. HAL cystectomy with an ileal conduit appears to have less estimated blood loss and postoperative analgesic requirements, shorter length of stay and earlier return of bowel function than open cystectomy. Oncological efficacy was preserved in the short term.
Taylor
Grant D
GD
Department of Urology, University of Texas Southwestern, Medical Center, Dallas, Texas, USA.
Duchene
David A
DA
Koeneman
Kenneth S
KS
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent