Videoendoscopically assisted transvaginal radical cystectomy

We describe our experience of anterior pelvic exenteration for bladder cancer in women using a combined transvaginal and laparoscopic approach. The feasibility of videoendoscopically assisted transvaginal cystectomy was demonstrated several years ago, but the indications have been greatly reduced by the spreading use of orthotopic neobladders in women. Moreover, nulliparous patients or patients with vaginal atresia are not suitable for this technique, even if the specimen can also be retrieved through the minilaparotomy used for performing urinary diversion. In the last 3 years, we have performed only four additional cases. Nevetheless, the results are satisfactory. We did not have any major intraoperative complication. Patients were discharged after 7 to 11 days (average 8.6 days) without any postoperative complications. The minimum survival was 13 months, and four patients are still alive. The operation itself is not easy and therefore can be offered only by centers where videoendosurgery has already entered common clinical practice.