title: Two-Port Approach Compared to Standard Laparoscopic Radical Cystectomy.
abstract: OBJECTIVE
  Two-port laparoscopic radical cystectomy (LRC) using a multichannel platform through the umbilicus and one additional 10-mm in the right iliac fossa has been recently described. We compare the perioperative and early results of this technique with a cohort of patients simultaneously treated in our institution with four-port LRC and a 7 to 10 cm midline incision.
  
  
  METHODS
  A matched-pair study comparing perioperative outcomes, postoperative visual analog pain scale (VAPS), and morbidity of two-port (n=30) and four-port (n=30) LRC. Preoperative and perioperative data analyzed and compared included demographics, type of urinary diversion, operative time, blood loss, transfusion requirements, decrease in serum hemoglobin, operative complications, analgesic needs, length of stay, number of nodes removed, and other pathologic information. Complications in the first 3 months were evaluated according to the Clavien-Dindo classification.
  
  
  RESULTS
  There was no significant difference between the two groups regarding patient age, gender, body-mass index, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, tumor stage, percent of positive nodes, positive margin rate, number of nodes retrieved, proportion of neobladders, secondary carcinoma in situ, incidental prostate cancer, or need of systemic chemotherapy. Median operative time was 20 minutes higher in the two-port procedure, but this difference was not statistically significant (p=0.2). Estimated blood loss and differential hemoglobin change were lower in the two-port technique (each p=0.03), but no difference was detected regarding the intraoperative or postoperative transfusion rate. Length of hospital stay was also equivalent. Differences were not observed either in the number or severity of complications. VAPS at days 2, 3, and 5 was significantly lower for two-port LRC (p<0.01).
  
  
  CONCLUSIONS
  Two-port LRC performed through an umbilical platform and an accessory 10-mm port seems technically equivalent to standard four-port LRC. Perioperative outcomes regarding hospital stay and complications are tantamount. Diminished blood loss and, especially, less postoperative pain favor the reduced-port approach in this complex urologic minimally invasive procedure.
authors.affiliation: Servicio de Urología, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe , Universidad Europea de Madrid, Madrid, Spain .
authors.forename: Javier C
authors.initials: JC
authors.lastname: Angulo
authors.affiliation: Servicio de Urología, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe , Universidad Europea de Madrid, Madrid, Spain .
authors.forename: Ana
authors.initials: A
authors.lastname: García-Tello
authors.affiliation: Servicio de Urología, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe , Universidad Europea de Madrid, Madrid, Spain .
authors.forename: Erika
authors.initials: E
authors.lastname: Mateo
authors.affiliation: Servicio de Urología, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe , Universidad Europea de Madrid, Madrid, Spain .
authors.forename: Helena
authors.initials: H
authors.lastname: Gimbernat
authors.affiliation: Servicio de Urología, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe , Universidad Europea de Madrid, Madrid, Spain .
authors.forename: Cristina
authors.initials: C
authors.lastname: Redondo
authors.affiliation: Servicio de Urología, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe , Universidad Europea de Madrid, Madrid, Spain .
authors.forename: Guillermo
authors.initials: G
authors.lastname: Andrés
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation / Q000379:methods*