Laparoscopic Radical Cystectomy And Urinary Diversion With Handport Assistance

Radical cystectomy is the standard of care for muscle invasive bladder cancer in the United States. Since the first reported simple laparoscopic cystectomy in 1992, multiple authors have reported on the use of laparoscopy for radical cystectomy (1). Gill et al. reported the first two cases of laparoscopic radical cystoprostatectomy with ileal conduit done completely intracorporeally in 2000 (2). A case report documented the use of the hand-assisted laparoscopic (HAL) technique for radical cystectomy with ileal conduit construction extracorpeally through the hand port for the first time (3). Since the first reported HAL cystectomy, two series reports for HAL cystectomy included seven and eight patients (4,5). Taylor et al. demonstrated in a prospective, non-randomized comparison that HAL cystectomy resulted in less blood loss (637 vs. 957 cc, p=0.23), decreased postoperative pain (31 vs. 149 mg morphine, p=0.01), shorter hospital stays (6.4 vs. 9.8 days, p=0.06) and decreased time to resumption of a regular diet (4.5 vs. 7.9 days, p=0.05) compared to open cystectomy. The immediate oncologic outcomes appear comparable in most laparoscopic cystectomy series, but long-term results are not available.