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      Gasless minimum incision access used for extracorporeal orthotopic bladder substitution after laparoscopic radical cystectomy

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          Abstract

          Introduction

          Radical cystectomy is the gold standard for treating invasive bladder cancer. We report our outcomes of gasless minimum incision access (GMIA) for extracorporeal orthotopic bladder substitution (ECOBS) after laparoscopic radical cystectomy.

          Material and methods

          Radical surgery was performed in patients in the same hospital suffering from bladder cancer in T2N0M0 G1–2 stage. Group 1 included 11 patients aged 56.6 (42–72) years, which underwent laparoscopic radical cystectomy and ECOBS using GMIA. Group 2 included 18 patients aged 56.7 (41–76) years, which were operated by open radical cystectomy and orthotopic bladder substitution.

          Results

          The average duration of operation was 492.0 ±85.7 minutes in Group 1 and 318.0 ±58.0 in Group 2 (p = 0.001). Estimated blood loss was 290.0 ±120.0 and 613.2 ±359.0 ml in groups respectively. In the postoperative period, narcotic analgesics were used in the amount of 166.0 ±28.0 mg and 264.0 ±112.0 mg (p = 0.05), intestinal function recovery was observed on 3.5 ±0.9 and 6.0 ±2.9 days after the operation (p = 0.05) in the groups respectively. Minor postoperative complications were observed in 36.4% and 56.0%, major complications – in 9.1% and 11.2% in groups respectively. Median hospitalization time was 19.0 ±2.0 days in Group 1 and 24.9 ±6.5 in Group 2 (p = 0.01).

          Conclusions

          GMIA in ECOBS can be used as an effective surgical approach after laparoscopic radical cystectomy; this method requires further observation.

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          Most cited references17

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          Abdominal sacrocolpopexy: a comprehensive review.

          Halina M. Zyczynski, , Linda Brubaker … (2004)
          To summarize published data about abdominal sacrocolpopexy and to highlight areas about which data are lacking. We conducted a literature search on MEDLINE using Ovid and PubMed, from January,1966 to January, 2004, using search terms "sacropexy," "sacrocolpopexy," "sacral colpopexy," "colpopexy," "sacropexy," "colposacropexy," "abdominal sacrocolpopexy" "pelvic organ prolapse and surgery," and "vaginal vault prolapse or surgery" and included articles with English-language abstracts. We examined reference lists of published articles to identify other articles not found on the electronic search. We examined all studies identified in our search that provided any outcome data on sacrocolpopexy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. Follow-up duration for most studies ranged from 6 months to 3 years. The success rate, when defined as lack of apical prolapse postoperatively, ranged from 78-100% and when defined as no postoperative prolapse, from 58-100%. The median reoperation rates for pelvic organ prolapse and for stress urinary incontinence in the studies that reported these outcomes were 4.4% (range 0-18.2%) and 4.9% (range 1.2% to 30.9%), respectively. The overall rate of mesh erosion was 3.4% (70 of 2,178). Some reports found more mesh erosions when concomitant total hysterectomy was done, whereas other reports did not. There were no data to either support or refute the contentions that concomitant culdoplasty or paravaginal repair decreased the risk of failure. Most authors recommended burying the graft under the peritoneum to attempt to decrease the risk of bowel obstruction; despite this, the median rate (when reported) of small bowel obstruction requiring surgery was 1.1% (range 0.6% to 8.6%). Few studies rigorously assessed pelvic symptoms, bowel function, or sexual function. Sacrocolpopexy is a reliable procedure that effectively and consistently resolves vaginal vault prolapse. Patients should be counseled about the low, but present risk, of reoperation for prolapse, stress incontinence, and complications. Prospective trials are needed to understand the effect of sacrocolpopexy on functional outcomes.
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            Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse.

            Susanne M. Axelsen, M Ellstrøm-Engh, Tapio Väyrynen … (2011)
            The use of standardized mesh kits for repair of pelvic-organ prolapse has spread rapidly in recent years, but it is unclear whether this approach results in better outcomes than traditional colporrhaphy. In this multicenter, parallel-group, randomized, controlled trial, we compared the use of a trocar-guided, transvaginal polypropylene-mesh repair kit with traditional colporrhaphy in women with prolapse of the anterior vaginal wall (cystocele). The primary outcome was a composite of the objective anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen), according to the Pelvic Organ Prolapse Quantification system, and the subjective absence of symptoms of vaginal bulging 12 months after the surgery. Of 389 women who were randomly assigned to a study treatment, 200 underwent prolapse repair with the transvaginal mesh kit and 189 underwent traditional colporrhaphy. At 1 year, the primary outcome was significantly more common in the women treated with transvaginal mesh repair (60.8%) than in those who underwent colporrhaphy (34.5%) (absolute difference, 26.3 percentage points; 95% confidence interval, 15.6 to 37.0). The surgery lasted longer and the rates of intraoperative hemorrhage were higher in the mesh-repair group than in the colporrhaphy group (P<0.001 for both comparisons). Rates of bladder perforation were 3.5% in the mesh-repair group and 0.5% in the colporrhaphy group (P=0.07), and the respective rates of new stress urinary incontinence after surgery were 12.3% and 6.3% (P=0.05). Surgical reintervention to correct mesh exposure during follow-up occurred in 3.2% of 186 patients in the mesh-repair group. As compared with anterior colporrhaphy, use of a standardized, trocar-guided mesh kit for cystocele repair resulted in higher short-term rates of successful treatment but also in higher rates of surgical complications and postoperative adverse events. (Funded by the Karolinska Institutet and Ethicon; ClinicalTrials.gov number, NCT00566917.).
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              Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review.

              J. Jelovsek, Christopher Maher, Gouri Diwadkar … (2009)
              To compare postoperative complication and reoperation rates for surgical procedures correcting apical vaginal prolapse. Eligible studies were selected through an electronic literature search covering January 1985 to January 2008 using PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews and Effects. Only clinical trials and observational studies addressing apical prolapse repair and recurrence or complication rates were included. The search was restricted to original articles published in English with 50 or more participants and a follow-up period of 3 months or longer. Oral platform and poster presentations from the American Urogynecological Society, the Society for Gynecologic Surgeons, the International Urogynecological Association, and the International Continence Society from January 2005 to December 2007 were hand searched to determine whether they were eligible for inclusion. Procedures were separated into three groups: traditional vaginal surgery, sacral colpopexy, and vaginal mesh kits. Complications were classified using the Dindo grading system. Weighted averages were calculated for each Dindo grade, complication, and reoperation. Dindo grade IIIa (433/3,425 women) and IIIb (245/3,425) rates were highest in the mesh kit group owing to higher rates of mesh erosion (198/3,425) and fistulae (8/3,425). Reoperation rates for prolapse recurrence were highest in the traditional vaginal surgery group (308/7,827). The total reoperation rate was greatest in the mesh kit group (291/3, 425, 8.5%). The rate of complications requiring reoperation and the total reoperation rate was highest for vaginal mesh kits despite a lower reoperation rate for prolapse recurrence and shorter overall follow-up.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cent European J Urol
                Journal ID (iso-abbrev): Cent European J Urol
                Journal ID (publisher-id): CEJU
                Title: Central European Journal of Urology
                Publisher: Polish Urological Association
                ISSN (Print): 2080-4806
                ISSN (Electronic): 2080-4873
                Publication date (Electronic): 18 August 2014
                Publication date (Print): 2014
                Volume: 67
                Issue: 3
                Pages: 302-309
                Affiliations
                State Financed Health Institution of the Republic of Mari El “Republican Clinical Hospital”, Yoshkar–Ola, Russia
                Author notes
                Correspondence Vasilii Dubrovin, Republic Clinical Hospital, 33, Osipenko Street, 424000 Yoshkar–Ola, Russia. phone: +79 613 793 500. vndubrovin@ 123456mail.ru
                Article
                Publisher ID: 00378
                DOI: 10.5173/ceju.2014.03.art18
                PMC ID: 4165680
                SO-VID: 6124adeb-66c4-4e02-8a3b-926f9630a31f
                Copyright © Copyright by Polish Urological Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 March 2014
                Date revision received : 04 April 2014
                Date accepted : 14 June 2014
                Categories
                Subject: Original Paper

                Keywords: laparascopic radical cystectomy,extracorporeal orthotopic bladder substitution,gasless single–port access
                Data availability:
                Keywords: laparascopic radical cystectomy, extracorporeal orthotopic bladder substitution, gasless single–port access

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