Two-port Laparoscopic Radical Cystectomy With Reusable Umbilical System: A Feasibility Study

OBJECTIVE To describe the technique and report outcomes of laparoscopic radical cystectomy using 2 ports (2-port LRC) for muscle-invasive bladder cancer. PATIENTS AND METHODS Prospective study was performed between November 2011 and October 2012 to standardize 2-port LRC, lymph node dissection, and urinary diversion. Twenty patients were intervened (8 ileal conduit, 12 neobladder) and followed up for >1 yr. Median follow-up was 75.5 weeks (interquartile range, 65.2-86 weeks). A reusable system placed through the umbilicus and laparoscopic curved instruments with double rotation, plus one 10-mm extra port placed in the right iliac fossa were used. Neobladder or conduit was performed extracorporeally. Preoperative, perioperative, and pathologic outcomes and long-term security data are presented. RESULTS Median age was 69.5 years; body mass index, 27.4 kg/m(2); operative time, 335 minutes; estimated blood loss, 337 mL; hospital stay, 9 days; intraoperative transfusion rate, 10%; and visual analog pain score, 3 at day 3. Surgical margin was positive in a case (5%); 3 (15%) were pT0, 2 (10%) pT1, 5 (25%) pT2, 6 (30%) pT3a, 3 (15%) pT3b, and 1 (5%) pT4. The number of nodes removed was 18.5 (interquartile range, 16-29.2), 4 (20%) positive. Complications were major in 2 (10%; fecal peritonitis and urinary sepsis) and minor in 4 (20%; ileus and 3 postoperative transfusion) cases. No case required additional analgesia. Incision was totally hidden in the umbilicus. Continence rate in neobladders was 91.7% at daytime and 75% at nighttime. Study limitation was the absence of a comparative cohort. CONCLUSION Umbilical 2-port LRC is feasible with good oncologic and functional outcomes, low postoperative pain, and absence of abdominal wall complications. Difficulties have slowed laparoendoscopic single-site radical cystectomy, but umbilical 2-port LRC is a very acceptable alternative for minimally invasive surgery of invasive bladder cancer. (C) 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).