ENDOUROLOGY & LAPAROSCOPY

Laparoscopic radical cystoprostatectomy with bilateral nephroureterectomy: initial report
Berglund RK, Matin SF, Desai M, Kaouk J, Gill IS
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
BJU Int. 2006; 97: 37-41

• Objectives: To present our experience with laparoscopic radical cystoprostatectomy and bilateral nephroureterectomy for organ-confined, muscle-invasive transitional cell carcinoma (TCC) of the bladder in two patients with dialysis-dependent end-stage renal disease (ESRD).
• Patients and Methods: Two men aged 77 and 65 years with organ-confined, muscle-invasive TCC of the urinary bladder and pre-existing dialysis-dependent ESRD underwent laparoscopic bilateral pelvic lymphadenectomy, radical cystoprostatectomy and bilateral nephroureterectomy. Urine spillage was avoided and en bloc urothelial integrity between the bladder and the two renal specimens was maintained throughout the procedure. The intact, entrapped specimens were removed en bloc via a Pfannenstiel incision at the end of the procedure.
• Results: The total operative duration was 573 and 660 min, respectively, including repositioning and re-draping between each major step. Blood loss was 350 and 1000 mL, respectively. Both patients tolerated the procedure well and there were no intraoperative complications. The first patient resumed oral intake 3 days after surgery and was discharged home after 5 days. The second patient’s course after surgery was complicated by a prolonged adynamic ileus and infection of the catheter placed for continuous ambulatory peritoneal dialysis. He was discharged 28 days after surgery and died from unknown causes at 30 days.
• Conclusions: To our knowledge, this is the first report of radical urotheliectomy, consisting of bilateral pelvic lymph node dissection, radical cystoprostatectomy, and bilateral nephroureterectomy, using entirely intracorporeal laparoscopic techniques.
  
  
• Editorial Comment
  This paper demonstrates a new era of laparoscopic procedures, which are extremely complicated. The oncological steps were respected and blood loss diminished for complex combined procedures. Although the number of patients was small, I believe the authors should be congratulated for the pioneer work in the area of minimally invasive surgery.

Dr. Fernando J. Kim
Chief of Urology, DHMC
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA