Hand assisted laparoscopic radical cystectomy for cancer bladder

Aim: To evaluate the efficacy, safety and feasibility of hand assistance in performing laparoscopic radical cystectomy and to describe our point of technique of hand assisted laparoscopic radical cystectomy (HALRC) with extra-corporeal ileal conduit reconstruction for muscle invasive bladder cancer. This is the second case report of HALRC in the world literature. Methods: A five-port transperitoneal laparoscopic approach with an indigenous hand port was used to perform the radical cystectomy in a patient with muscle invasive TCC of bladder. After specimen retrieval, ileal conduit reconstruction was performed extra-corporeally through the site of hand port incision. Results: HALRC was successfully completed in 4.3 hrs and the patient was discharged on the 7th day. The blood loss was 500 ml, and patient was transfused 2 units of blood, as the pre operative hemoglobin was 9 gms%. The analgesic requirement was 350 mgs of Pethidine (equivalent to 35 mgs of Morphine) and 450 mgs of oral Diclofenac Sodium. It took about 23 days for patient to resume normal activity. The histopathology was reported as T3b, left perivesical margin was positive and 2/5 of left pelvic lymph nodes were also involved. However, 7 lymph nodes removed from the right side did not show any disease. In view of histopathology report patient was given 4 cycles of postoperative chemotherapy. At the current follow up of 25 months the patient is free of any recurrence of disease. Conclusion: This case demonstrates the applicability of hand port assistance in to the laparoscopic field inside the abdomen, which helps in retraction and performing blunt dissection coupled with tactile sensation. It is feasible to use hand during laparoscopic radical cystectomy. Its usefulness has to be weighed against the standard laparoscopic radical cystectomy and additional time required for setup and the added cost. The technical success rate currently for standard laparoscopic radical cystectomy clearly demonstrates that hand assistance is not necessary. But, just as its applicability is being investigated, its role should be assessed in larger series of laparoscopic radical cystectomy.