Laparoscopic radical cystectomy in the female.
OBJECTIVE
We detail the technique of completely intracorporeal laparoscopic radical cystectomy in the female patient, which has previously not been well described in the literature. Additionally, perioperative and short-term oncological outcome data are presented.


METHODS
Since 2000, 11 female patients underwent laparoscopic radical cystectomy for bladder carcinoma. Data were collected with respect to patient demographics, perioperative outcomes and short-term oncological followup.


RESULTS
Mean patient age was 66 years (range 42 to 80) and the mean body mass index was 25 (range 17 to 34). Mean total operative time was 8.5 hours (range 6.5 to 10.5), including an average radical cystectomy time of 2 to 2.5 hours. Estimated blood loss was 489 cc (range 150 to 1,000). Reconstructive procedures were an ileal conduit in 8 patients, Studer orthotopic neobladder in 2 and continent Indiana pouch in 1. Mean hospital stay was 6 days (range 5 to 12). No case was converted to open surgery. Complications occurred in 4 patients, including internal hernia requiring laparotomy 19 days postoperatively, deep vein thrombosis with pulmonary embolism, dehydration and urinary tract infection in 1 each. At a median followup of 7.1 months (range 1 to 19) 8 patients (73%) had no evidence of disease, 1 (9%) had metastasis and 2 (11%) had died.


CONCLUSIONS
Laparoscopic radical cystectomy in the female is technically efficacious. Our techniques of anterior pelvic exenteration, and uterus/fallopian tube/ovary and nerve sparing laparoscopic female radical cystectomy are presented. Short-term functional and oncological outcomes appear favorable.
Moinzadeh
Alireza
A
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Gill
Inderbir S
IS
Desai
Mihir
M
Finelli
Antonio
A
Falcone
Tommaso
T
Kaouk
Jihad
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D020681:Colposcopes; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation / Q000379:methods; D016476:Urinary Reservoirs, Continent