Laparoscopic complete urinary tract exenteration with the specimen withdrawn transvaginally
Ching-Chia Li1, Hsun-Shuan Wang, Wen-Jeng Wu
1Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
BJU International
|January 22, 2009
Summary
Laparoscopic complete urinary tract exenteration (LaCUTE) offers a minimally invasive approach for urothelial cancer, demonstrating reduced blood loss compared to open surgery. Further refinement may enhance its feasibility for select patients.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Complete urinary tract exenteration (CUTE) is a radical surgical procedure for advanced pelvic malignancies.
- Traditional open CUTE involves significant morbidity.
Purpose of the Study:
- To describe the technique of laparoscopic complete urinary tract exenteration (LaCUTE).
- To compare outcomes of LaCUTE with traditional open CUTE.
Main Methods:
- A retrospective review of five patients undergoing LaCUTE and three undergoing open CUTE.
- Surgical procedure included bilateral nephroureterectomy, pelvic lymphadenectomy, cystourethrectomy, hysterectomy, and salpingo-oophorectomy.
- Specimens were withdrawn en bloc through the vagina in the LaCUTE group.
Main Results:
- LaCUTE group: mean age 58 years, blood loss 378 mL, operative time 492 min, hospital stay 12.2 days.
- All patients achieved negative surgical margins.
- LaCUTE group had significantly less blood loss but longer operative duration than the open group.
- No cancer recurrence observed at mean follow-up of 14.5-16.0 months in either group.
Conclusions:
- LaCUTE with vaginal specimen en bloc withdrawal is a feasible technique.
- Further experience and technique refinement can improve its applicability for uraemic female patients with urothelial cancer.
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