slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Department of Urology, Kangnam St. Mary’s Hospital The Catholic University of Korea, College of Medicine Yoo Shin Ha PowerPoint Presentation
Download Presentation
Department of Urology, Kangnam St. Mary’s Hospital The Catholic University of Korea, College of Medicine Yoo Shin Ha

Loading in 2 Seconds...

play fullscreen
1 / 26

Department of Urology, Kangnam St. Mary’s Hospital The Catholic University of Korea, College of Medicine Yoo Shin Ha - PowerPoint PPT Presentation


  • 161 Views
  • Uploaded on

Laparoscopic Radical Cystectomy in Catholic University Experience. Department of Urology, Kangnam St. Mary’s Hospital The Catholic University of Korea, College of Medicine Yoo Shin Ha. Introduction. Radical cystectomy : the gold standard for M. invasive or high risk bladder cancer .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Department of Urology, Kangnam St. Mary’s Hospital The Catholic University of Korea, College of Medicine Yoo Shin Ha' - yana


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Laparoscopic Radical Cystectomy

in Catholic University Experience

Department of Urology, Kangnam St. Mary’s Hospital

The Catholic University of Korea, College of Medicine

Yoo Shin Ha

slide2

Introduction

Radical cystectomy :

the gold standard for M. invasive or high risk bladder cancer

Laparoscopic surgery :

expanding

now applied to treat neoplasm ofthe pelvic organ

Excellent perioperative & long-term results in RCC, Prostate ca.

.

Encourage to explore the role of

laparoscopy in bladder ca.

.

slide3

To define the role of laparoscopic radical cystectomy ?

  • The main problems to solve
  • Technical difficulty
  • Urinary diversion method
  • intracorporeally ? or extracorporeally ?
  • Oncologic risk , replicating the outcome of open surgery ?

.

To overcoming these problems, We would like to share

our experience with LRC in 36 cases, since june 2003,

.

slide4

Pathogenesis

The steps of operations

Port placement

Camera port

Marking incision site

for specimen removal

5-port fan-shaped

transperitoneal approach

slide5

Mobilization & division of the ureters

  • Important landmarks
  • Medial umbilical lig.
  • Vas
  • Rectovesical pouch
  • Iliac vessels
  • Incision of Peritoneum
  • dissection down to the
  • UVJ
  • isolation of ureter
  • as distally as possible
  • Frozen biopsy

.

.

slide6

Posterior dissection

  • Transverse peritoneotomy
  • at arch of douglas pouch
  • Developing plane Between
  • SV, prostate and the rectum
  • Denonvilliers’ fascia
  • Prerectal fat

.

.

slide7

Anterior dissection

  • Bladder is filled with saline
  • starting lateral to medial
  • umbilical lig.
  • divide urachus
  • the prevesical space is opened

.

.

slide8

Endopelvic fascia incision & DVD control

  • Exposure of endopelvic fascia
  • Incision on line of reflection
  • Separation from the levator ani M.
  • Suture of DVC (3-0 PDS)

.

.

slide9

Lateral dissection

  • Retracting bladder medially
  • away to the ext. iliac V
  • Divide the vesical & prostatic
  • fibrovascular pedicles
  • Sono-surg andHem-o-lok clip

.

.

slide10

Apex dissection

  • divide the DVC & expose urethra
  • To prevent contamination ,
  • occlude the urethra
  • divide the urethra & posterior
  • attachment

.

.

slide11

Extended PLND

  • Ant. to Ext. iliac artery and
  • medial to genitofemoral N.
  • along the Ext. iliac vein
  • and the medial side of
  • pelvic wall
  • Obturator N.
  • Along the common iliac A.
  • up to the aortic bifurcation

.

.

slide12

Extracorporeal urinary diversion

  • through incision for speciemen
  • removal
  • GIA stappler
  • ileal conduit or ileal neobladder
  • is made in the usual manner
  • 4th port expanded for stoma

.

.

slide14

Result

  • June 2003 – MAY 2008
  • LRC : 36 patients
  • Male 32, Female 4
  • Mean age (SD) : 67.35 (± 10.1)
  • Mean BMI (SD) : 23.2 (± 2.4)
slide15

Perioperative characteristics

  • Mean total operative time (SD) : 573.9 (± 108.0)
  • Ileal conduit group : 557.7 (± 98.9)
  • Neobladder group : 698.8 (± 104.3)
  • Mean estimated blood loss (SD) : 709.5 (± 496.1)
  • Days to ambulation : 4.1 days (3-5)
  • Days to oral intake : 4.5 days (2-6)
  • Post-op hospital stay : 12.8 days (7-26)
  • Urethrectomy : 17 cases
slide16

Perioperative complications

  • Cystectomy and PLND could be completed laparoscopically
  • without conversion & complications
  • no rectal injury
  • no major vessel injury
slide17

Urinary diversion

Constructed extracorporeally through the same incision

Diversion : Ileal conduit 32 patients

W-neobladder 3 (open conversion 2)

Y-neobladdr 1 (open conversion 1)

Ileal conduit

W-neobladder

Y-neobladder

opening

opening

caudal

cranial

urethrectomy
Urethrectomy
  • Indications : carcinomatous involvement of the urethra,

typically prostatic urethra

  • High risk of urethral recurrence

Campbell-Walsh urology 9th ed.

involvement of the prostatic urethra

multifocal disease

the presence of carcinoma in situ (CIS)

involvement of the bladder neck

upper tract TCC

Urol Clin North Am 2005;32:199-206

urethrectomy in catholic experience
Urethrectomy in catholic experience
  • Of total 36 patients, 17 cases of total urethrectomy was done
  • In 17 cases

Positive margin of urethra : 4 cases

involvement of the bladder neck : 9 cases

the presence of carcinoma in situ (CIS) : 1 cases

involvement of the prostatic urethra : 3 cases

slide20

Pathological outcomes

Among total 36 cases, distant metastasis - 7 cases

Local recurrence – 2 cases

standard plnd vs extended plnd
Standard PLND vs Extended PLND
  • lymphatic tissue of
  • common iliac V and
  • up to aortic bifurcation
  • More accurate staging
  • Therapeutic benefit

Urol Steven K, Poulsen AL J Urol 2007

Mills et al ; Surg Oncol Clin N Am 2007

extended plnd in catholic experience after 25 th case
Extended PLND in catholic experienceafter 25th case

Standard PLND – 12.8 (4 - 22)

Extended PLND – 16.9 (12 - 26)

slide23

Oncological outcomes

  • In catholic experience
  • oncological efficacy comparable to other reports of LRC
  • possible to replicate oncologic results of ORC

Long term (over 5 yrs) oncologic survey

Large scale survey

slide24

CONCLUSION ;

The main problems to define the role LRC

  • Technical difficulty
  • Urinary diversion method

Laparoscopic radical cystectomy is technically feasible

.

  • Extracorporeal urinary diversion with small incision
  • maintains the benefits of laparoscopy
  • safe and effective method
  • providing comparable perioperative and functional outcomes
  • as open suregery

Oncologic risk , replicating the outcome of open surgery ?

.

Need for technical advance for orthotopic neobladder !!

slide25

Oncologic risk , replicating the outcome of open surgery ?

Not yet !!

  • Oncological outcomes from several centers’ experiences
  • including catholic university may suggest the possiblity of
  • replicating oncological outcomes of ORC
  • Large number and long-term oncologic data is required to
  • document long term cancer control with LRC

.

.