Gasless minimum incision access used for extracorporeal orthotopic bladder substitution after laparoscopic radical cystectomy

Introduction Radical cystectomy is the gold standard for treating invasive bladder cancer. We report our outcomes of gasless minimum incision access (GMIA) for extracorporeal orthotopic bladder substitution (ECOBS) after laparoscopic radical cystectomy. Material and methods Radical surgery was performed in patients in the same hospital suffering from bladder cancer in T2N0M0 G1-2 stage. Group 1 included 11 patients aged 56.6 (42-72) years, which underwent laparoscopic radical cystectomy and ECOBS using GMIA. Group 2 included 18 patients aged 56.7 (41-76) years, which were operated by open radical cystectomy and orthotopic bladder substitution. Results The average duration of operation was 492.0 +/- 85.7 minutes in Group 1 and 318.0 +/- 58.0 in Group 2 (p = 0.001). Estimated blood loss was 290.0 +/- 120.0 and 613.2 +/- 359.0 ml in groups respectively. In the postoperative period, narcotic analgesics were used in the amount of 166.0 +/- 28.0 mg and 264.0 +/- 112.0 mg (p = 0.05), intestinal function recovery was observed on 3.5 +/- 0.9 and 6.0 +/- 2.9 days after the operation (p = 0.05) in the groups respectively. Minor postoperative complications were observed in 36.4% and 56.0%, major complications - in 9.1% and 11.2% in groups respectively. Median hospitalization time was 19.0 +/- 2.0 days in Group 1 and 24.9 +/- 6.5 in Group 2 (p = 0.01). Conclusions GMIA in ECOBS can be used as an effective surgical approach after laparoscopic radical cystectomy; this method requires further observation.