Laparoscopic partial cystectomy for urachal and bladder cancer.
To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy.



Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation.



All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation.



Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.
Colombo
Jose R
JR
Section of Laparoscopic and Robotic Surgery, Cleveland Clinic, Glickman Urological Institute, Cleveland, Ohio, USA. betocolombo@hotmail.com
Desai
Mihir
M
Canes
David
D
Frota
Rodrigo
R
Haber
Georges-Pascal
GP
Moinzadeh
Alireza
A
Tuerk
Ingolf
I
Desai
Mahesh R
MR
Gill
Inderbir S
IS
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016896:Treatment Outcome; D014497:Urachus / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*