Mini-laparotomy approach to radical cystectomy.

Objective: • To investigate the feasibility of performing radical cystectomy (RC) through a mini-laparotomy and to evaluate the effect of a smaller incision on wound problems, immediate postoperative pain, bowel function and length of hospital stay (LOS).

Patients And Methods: • Two consecutive cohorts of patients, one with 75 patients undergoing open RC (ORC) with lymph node dissection up to the aortic bifurcation through a conventional long midline incision and one with 75 patients undergoing RC through a mini-laparotomy (MinilapRC) of intentionally <8-10 cm. • Patient characteristics, operative duration, estimated blood loss (EBL), incidence and severity of wound problems, return of bowel function, amount of analgesics needed and LOS were analysed according to the intention-to-treat principle.

Results: • The demographic characteristics of the two groups were similar. • An incision of ≤10 cm was made in 65% of the patients in the MinilapRC group with a median (range) length of incision of 9 (6.5-19) cm. In the final third of patients operated on in the MinilapRC group, 76% had an incision of ≤8 cm. • The operative duration and EBL were not significantly different between the groups. • Wound problems were significantly fewer, bowel function was restored more quickly and the need of postoperative analgesics was less in the MinilapRC group. • In the MinilapRC group LOS was reduced by a median of 3 days.

Conclusion: • MinilapRC is feasible in most patients without increasing operative duration. The reduced incision length reduces postoperative morbidity.