Laparoscopic radical cystectomy:: Initial series and analysis of results

Introduction: We present our series of laparoscopic radical cystectomies. The program was started when our department had a previous experience of nearly 500 laparoscopic radical prostatectomies, which allowed this series to be performed with virtually no learning curve. Methods: From January 2005 to May 2006, we performed 35 laparoscopic radical cystectomies in 8 women and 27 men. Because of the high rate of ureterointestinal stenosis detected in the first 26 cases (19.2%, 5 of 26), we changed from open to laparoscopic urinary diversion. With this change, the rate has currently decreased to 14.2% (5 of 35). Results: Mean surgical time was 5.59 h for open urinary diversion and 9.42 h for pure laparoscopic surgery, with a mean blood loss of 488.57 ml and a mean hospital stay of 14.11 d. The mean number of nodes at lymphadenectomy was 13.5 (range: 5-24) and 37.1% of patients had lymph node involvement. Conclusions: Radical cystectomy is one of the most aggressive urologic surgeries, but numerous publications have shown that it can benefit from the advantages of laparoscopy. The question of whether open or laparoscopic methods are preferable for urinary diversion remains a subject of debate. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.