Pelvic lymphadenectomy (staging) in patients with bladder cancer laparoscopic versus open approach

In the period 01.01.93 to 01.02.95 a total number of 40 patients underwent a diagnostic pelvic lymphadenectomy. All patients had bladder carcinoma. Twenty-one had the procedure performed as an open operation and 19 had a laparoscopic approach. The groups were comparable as to age, sex and tumor stage. The median number of harvested lymph nodes was found to be the same in the two groups (median 5 lymph nodes). The percentage of lymph node positive patients was comparable -5 of 21 in the open and 4 of 19 in the laparoscopic group. One patient in the laparoscopy group had to be converted to an open procedure because of peroperative bleeding. In the open group one accidental ureteric lesion occurred. It was repaired intraoperatively. Only few postoperative complications were seen. In the open group two cases of troublesome lymphoceles occurred and one case of wound infection. In the laparoscopy group one patient experienced prolapse of an omental snip through a port incision and one patient had a scrotal haematoma which resolved spontaneously. The need for postoperative analgesia was significantly less in the laparoscopy group. The postoperative hospital stay was 8 days in the open versus 1 day in the laparoscopy group.