2610 994479, 2613 603969, 6932480650
Rio, 26504, Achaia, Greece View Location
Laparoscopic Radical Cystectomy – surgical removal of urinary bladder, prostate, (terminal portion of ureters ) (urethra) (LN) and reconstruction of urinary tract continuity

  • Indications
  • Usual patients
    • Patients with muscle-invasive bladder cancer (T2-T4a)
  • Selected patients
    • Patients with high risk, recurrent Tis and/or T1G3 after BCG failure
    • Patients with large papillary tumors refractory to TUR and intravesical treatment
    • Salvage cystectomy for patients with tumors refractory to standard therapies
    • Palliative cystectomy for patients with severe complications from tumor extension

  • Methods and comparison
  • Surgical steps
    • 1. Positioning of patient
    • 2. Planning and placement of trocars
    • 3. Entry into peritoneal cavity
    • (WEB SURG SUMMARY VanVelthoven)
      • 1. Dissection of prerectal space (seminal vesicles left intact)
      • 2. High peritoneal incision from along the ureters until internal inguinal ring
      • 3. Division of ductus deferens, using a medial retractor
      • 4. Extended pelvic lymph node dissection (ilio-obturator, internal iliac/medial external iliac): both the extent of node dissection and the number of lymph nodes removed has a direct impact on survival for both negative and positive node patients)
      • 5. Division of ureter (once clamped)
      • 6. Merging of peritoneal incisions; division of superior, inferior vesical artery, vesicular arteries
      • 7. Late division of urachus and umbilical ligaments
      • 8. Dissection of Retzius’ space
      • 9. Complete dissection of the endopelvic fascia
      • 10. Dissection along the prostate for preservation of neurovascular bundles (intrafascial: Aphrodite’s veil)
      • 11. Complete dissection of urethra
      • 12. Retrieval of the closed specimen “en bloc”
      • Laparoscopic anastomosis to the urethra in orthotopic bladder replacement

  • Continent diversion
    • Heterotopic
    • Orthotopic
      • Abol –Eneim
      • Studer
  • Incontinent diversion
    • Cutaneous diversion
    • Ileo-uretero-dermostomy (Bricker, Wallace, etc)