title: Perioperative outcomes with laparoscopic radical cystectomy: "pure laparoscopic" and "open-assisted laparoscopic" approaches.
abstract: OBJECTIVE
  Techniques for laparoscopic radical cystectomy are rapidly evolving. The entire procedure can be performed completely intracorporeally by pure laparoscopic techniques or by open-assisted laparoscopic techniques in which the urinary diversion is constructed extracorporeally by way of a minilaparotomy incision. We retrospectively evaluated the outcomes of these two techniques with a focus on perioperative outcomes and associated morbidity.
  
  
  METHODS
  From December 1999 to March 2006, 54 patients underwent laparoscopic radical cystectomy for muscle invasive (n = 35) or high-risk non-muscle-invasive (n = 19) bladder cancer. The mean follow-up was 25 months (range, 1 to 66 months).
  
  
  RESULTS
  Of the 54 patients, 17 underwent a pure laparoscopic (group 1, 8 conduit and 9 neobladder) and 37 underwent an open-assisted laparoscopic (group 2, 18 conduit and 19 neobladder) procedure. No significant differences were noted between the groups in patient age, comorbidities, or pathologic stage of malignancy. Group 2 was superior with regard to operative time, blood loss, transfusion rate, time to oral intake, time to ambulation, and postoperative complications (P <0.05 for all comparisons). Anastomotic leak, bowel obstruction, or sepsis requiring reexploration developed in 5 patients (29%) in group 1 and 4 patients (11%) in group 2. A "learning curve" was observed for both procedures, but it was particularly steep for the pure laparoscopic technique, and this approach was eventually abandoned.
  
  
  CONCLUSIONS
  Laparoscopic radical cystectomy is associated with a learning curve, with morbidity largely resulting from the urinary diversion procedure. Our experience suggests that the open-assisted laparoscopic approach is technically more efficient and associated with a quicker recovery profile and decreased complication rates compared with the pure laparoscopic approach.
authors: Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors: Georges-Pascal
authors: GP
authors: Haber
authors: Steven C
authors: SC
authors: Campbell
authors: Jose R
authors: JR
authors: Colombo
authors: Amr F
authors: AF
authors: Fergany
authors: Monish
authors: M
authors: Aron
authors: Jihad
authors: J
authors: Kaouk
authors: Inderbir S
authors: IS
authors: Gill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods