Simultane roboterassistierte laparoskopische Zystektomie und laparoskopische Nephrektomie: Erste Erfahrungen an 3 Patienten mit Kurzzeit-Follow-up

Abstract

BACKGROUND: The standard treatment for the muscle-invasive bladder cancer (MIBC) adheres to the open radical cystectomy (RC), although in the last few years the RC was established in some centres. The MIBC with simultaneous renal pathology (carcinoma, loss of function) can be a reason for an RC in combination with a nephrectomy. In the present paper we give a report about our first 3 patients in whom we combined the robotic RC with a laparoscopic nephrectomy as a minimally invasive treatment. PATIENTS AND METHODS: Between January and September 2010 3 male patients (average age 66 years) with MIBC and an associated renal pathology (2×loss of function, 1×upper tract carcinoma) were treated by the simultaneous robot-assisted RC and laparoscopic nephrectomy at our hospital. Clinical and pathological criteria, surgical techniques and preoperative complications were recorded prospectively. Follow-up of the 3 patients continued for at least of 18 months. RESULTS: In all 3 cases primarily the kidney was prepared in a transperitoneal-laparoscopic way and clipped by the vessel pedicle, then the robot-assisted RC followed and specimens were removed through a 10-cm median laparotomy. In all cases an ileum conduit was built extracorporally in using this way. The median OP time (including nephrectomy, connection of Da-Vinci, RC with extended lymph node dissection) amounted to 7 h (6.5-7.5 h) in total. The intraoperative blood loss was 330 mL on average. One of our patients showed a grade 2 complication following the Clavien-Dindo classification (1×grade 1, 1×without perioperative complications). On average 32 (22-46) lymph nodes were taken out, whereby all patients showed a pN0 status. The pathological stagings of MIBC were pT3a, pT4a and pT4b. With one patient the cancer of the renal pelvis was limited to the lamina propria, with another patient an incidental prostate cancer was detected. All histopathological findings of the different cancers showed negative surgical margins. The median hospitalisation time was 17 (16-19) days. In an 18- to 26-month follow-up period all patients ­remained without any further postoperative complications and ­without a tumour relapse. CONCLUSION: In this paper we have described the surgical steps of a small series of simultaneous robot-assisted RC and laparoscopic nephrectomy as a minimally invasive treatment in case of a specific indication. As a result of our report, we show that this surgical technique is possible without essential perioperative morbidity and with satisfying oncological results. Long-term data of our patients and results of any further studies are crucial to evaluate the efficiency of this complex surgical method.