Hand-assisted laparoscopic radical cystectomy and extracorporeal urinary diversion: experience with 31 cases.

Objectives: To report our techniques and experience with hand-assisted laparoscopic radical cystectomy and extracorporeal urinary diversion for bladder cancer.

Methods: Between May 2004 and November 2007, 31 patients (mean age 61.3 years, range 40-79) underwent hand-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion for bladder cancer. Five patients had previously undergone abdominal surgeries. Data were collected with respect to patient demographics, perioperative outcomes and short-term oncological follow up.

Results: Twenty-four patients underwent an ileal conduit and seven patients underwent an orthotopic neobladder. Mean operative time was 365.7 min (range 245 to 530). Estimated blood loss was 250.9 cc (range 100 to 500), with a transfusion rate of 9.7%. Oral liquids were resumed at 4.3 days and the mean hospital stay was 19.7 days. There were no intraoperative complications. Postoperative early complications (within 30 days of surgery) occurred in six patients (19.4%). Two wound infections, one urinary leak, one wound dehiscence, one bowel obstruction and one alimentary tract hemorrhage were all treated conservatively. Late complications occurred in three patients (two parastomal hernias and one ureteroenteric stricture). With a mean follow up of 18 months, 27 patients had no evidence of disease. One patient died because of cancer and one died for unrelated causes. One was alive with local recurrences and one with lung metastasis.

Conclusions: Hand-assisted laparoscopic radical cystectomy is a safe, reproducible and minimally invasive option for bladder cancer patients.