RECONSTRUCTIVE UROLOGY

Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder
Beecken WD, Wolfram M, Engl T, Bentas W, Probst M, Blaheta R, Oertl A, Jonas D, Binder J
Department of Urology and Pediatric Urology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
Eur Urol. 2003; 44: 337-9

• Purpose: To describe our technique of robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic neobladder (Hautmann) for treatment of transitional cell carcinoma of the bladder.
• Methods: We describe our surgical technique in the worldwide first attempt to perform a robotic-assisted laparoscopic radical cystectomy and completely intra-abdominal formation of an orthotopic neobladder. The DaVinci System™ (Intuitive Surgical, Mountain View, CA, USA) was utilized to perform the procedure.
• Results: Utilizing the DaVinci System the operation could be performed without any complications. Operating time was 8.5 hours, blood loss was 200 ml. The oncologic as well as the functional result of the reservoir were excellent.
• Discussion: We here demonstrated that sophisticated laparoscopic procedures like the intra-abdominal formation of an orthotopic neobladder are accomplishable with robotic assistance.
  
  
• Editorial Comment
  Over the recent years experience with laparoscopic tumor ablation in urology has been increasing. In many centers worldwide adrenalectomy, total or partial nephrectomy and radical prostatectomy are now regularly performed. Although reports on radical cystectomy do exist, this procedure has always been thought to be problematic for minimal invasive surgery due to the necessity of a subsequent reconstructive urinary diversion.
  In this paper by Beecken et al., the authors have managed to perform a laparoscopic radical cystectomy and an orthotopic ileal neobladder completely intracorporeally. Contrary to other reports the type of urinary diversion was similar to the urinary diversion used by open surgery. The difference lies in a different sequence of the procedure mainly for the neobladder. Although the time to perform such a procedure is respectable compared to some previous reports, it is still considerably longer than experienced surgeons would necessitate for an open procedure. Furthermore an expensive and sophisticated computerized robotic system available only in a few centers worldwide was used and most probably accounted for the success. It shows however that laparoscopic radical cystectomy and an orthotopic ileal neobladder will be improved with the development of new tools and that we are faced with the fact that in several years from now centers of excellence may perform also this procedure less invasive, and probably in a comparable time period. The increased cost of such equipment will have to be equated with reduced patients’ hospitalization, morbidity and earlier return to work.

Dr. Arnulf Stenzl
Professor and Chairman of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany