Hand-assisted laparoscopic bladder cuff excision via the same hand port as that used for nephroureterectomy
Geehyun Song1,2, Kyung-Sik Han1, Sang Hoon Song1
1Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
Purpose:
The aim of this study was to report our technique of hand-assisted laparoscopic bladder cuff excision through the same hand port as that used for nephroureterectomy and evaluate its benefits and short-term oncologic outcomes.
Materials And Methods:
We included 67 consecutive patients treated by a single surgeon between June 2011 and November 2014 with hand-assisted laparoscopic bladder cuff excision through the same hand port as that used for nephroureterectomy. We retrospectively analyzed procedure-related clinical data and short-term oncologic outcomes.
Results:
The mean patient age was 66.2 ± 10.6 years. The mean follow-up period was 17.6 months (range 1-37 months). The mean operation time was 243.5 ± 60.4 min. There were no major accidents or open conversions. Forty-two patients (63 %) underwent immediate mitomycin C instillation without complications. There was one high-grade complication (prolonged lymphatic leakage) that required reoperation and multiple hospitalizations. Thirty patients (45 %) underwent regional lymph node dissection. The pathological stages included CIS in 2 (3 %), Ta/T1 in 32 (48 %), T2 in 6 (9 %), T3 in 27 (40 %), and N+ in 4 (6 %) cases. G1, G2, and G3 were seen in 3 (5 %), 21 (31 %), and 43 (64 %) patients, respectively. Eighteen patients (26 %) underwent postoperative adjuvant chemotherapy. Two patients died during the study period, and nine patients (13 %) had bladder recurrences.
Conclusions:
HAL bladder cuff excision through the same hand port used for nephroureterectomy is a feasible technique that is both amenable to oncologic principles and can reproduce the open surgical technique.
