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Cystoscopic-assisted partial cystectomy: description of technique and results.

Gofrit ON, Shapiro A, Katz R, Duvdevani M, Yutkin V, Landau EH, Zorn KC, Hidas G, Pode D - Res Rep Urol (2014)

Bottom Line: The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088).Overall, disease-specific and disease-free survival rates were similar.Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.

ABSTRACT

Background: Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder.

Methods: During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy.

Results: Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar.

Conclusion: The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

No MeSH data available.


Related in: MedlinePlus

(A) An intraoperative view. A midline lapartomy was performed and the bladder isolated. The lights in the operating room were turned off. The surgeon pointed the cystoscope toward one of the poles of the planned ellipse around the tumor. The assistant marks this point with a cautery. (B) The marked incision was deepened, the bladder edge lifted with Allis clamps, and the tumor identified. (C) A removed specimen showing only a crater. (D) A removed specimen showing a bulky (pT3) tumor. This patient was operated on at the age of 54 years and is disease-free 85 months after surgery.
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f1-rru-6-139: (A) An intraoperative view. A midline lapartomy was performed and the bladder isolated. The lights in the operating room were turned off. The surgeon pointed the cystoscope toward one of the poles of the planned ellipse around the tumor. The assistant marks this point with a cautery. (B) The marked incision was deepened, the bladder edge lifted with Allis clamps, and the tumor identified. (C) A removed specimen showing only a crater. (D) A removed specimen showing a bulky (pT3) tumor. This patient was operated on at the age of 54 years and is disease-free 85 months after surgery.

Mentions: Under general or regional anesthesia, the abdomen and penis are scrubbed and draped. A catheter is inserted in the sterile field. Midline laparotomy is then performed. In most cases, this requires opening of the peritoneum. The transperitoneal approach permits wider excision of the bladder dome with its perivesical fat and the peritoneal covering. The bladder is then mobilized. The overhead operative lights are then turned off and the catheter is removed. Flexible cystoscopy is performed by the senior surgeon. The tumor or its crater are identified and the surgeon plans an elliptic incision around the tumor, thereby leaving 1–2 cm of normal bladder mucosa around it. The surgeon points the cystoscope toward one of the poles of the planned ellipse (Figure 1A). The assistant identifies the transillumination in the operative field and marks this point with a cautery. The cystoscope is removed and a catheter reinserted. The overhead lights are turned on, the bladder around the marked incision is packed with lap pads, and the mark is deepened to the mucosa. The bladder edge is lifted with Allis clamps and the tumor is identified (Figure 1B). The incision around the tumor is completed (Figure 1C and D). The specimen is submitted for frozen section examination to confirm the absence of microscopic disease at the margin. The bladder is then closed in the usual manner with two-layer closure and standard pelvic lymphadenectomy (including the external iliac and obturator nodes) is performed.


Cystoscopic-assisted partial cystectomy: description of technique and results.

Gofrit ON, Shapiro A, Katz R, Duvdevani M, Yutkin V, Landau EH, Zorn KC, Hidas G, Pode D - Res Rep Urol (2014)

(A) An intraoperative view. A midline lapartomy was performed and the bladder isolated. The lights in the operating room were turned off. The surgeon pointed the cystoscope toward one of the poles of the planned ellipse around the tumor. The assistant marks this point with a cautery. (B) The marked incision was deepened, the bladder edge lifted with Allis clamps, and the tumor identified. (C) A removed specimen showing only a crater. (D) A removed specimen showing a bulky (pT3) tumor. This patient was operated on at the age of 54 years and is disease-free 85 months after surgery.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216031&req=5

f1-rru-6-139: (A) An intraoperative view. A midline lapartomy was performed and the bladder isolated. The lights in the operating room were turned off. The surgeon pointed the cystoscope toward one of the poles of the planned ellipse around the tumor. The assistant marks this point with a cautery. (B) The marked incision was deepened, the bladder edge lifted with Allis clamps, and the tumor identified. (C) A removed specimen showing only a crater. (D) A removed specimen showing a bulky (pT3) tumor. This patient was operated on at the age of 54 years and is disease-free 85 months after surgery.
Mentions: Under general or regional anesthesia, the abdomen and penis are scrubbed and draped. A catheter is inserted in the sterile field. Midline laparotomy is then performed. In most cases, this requires opening of the peritoneum. The transperitoneal approach permits wider excision of the bladder dome with its perivesical fat and the peritoneal covering. The bladder is then mobilized. The overhead operative lights are then turned off and the catheter is removed. Flexible cystoscopy is performed by the senior surgeon. The tumor or its crater are identified and the surgeon plans an elliptic incision around the tumor, thereby leaving 1–2 cm of normal bladder mucosa around it. The surgeon points the cystoscope toward one of the poles of the planned ellipse (Figure 1A). The assistant identifies the transillumination in the operative field and marks this point with a cautery. The cystoscope is removed and a catheter reinserted. The overhead lights are turned on, the bladder around the marked incision is packed with lap pads, and the mark is deepened to the mucosa. The bladder edge is lifted with Allis clamps and the tumor is identified (Figure 1B). The incision around the tumor is completed (Figure 1C and D). The specimen is submitted for frozen section examination to confirm the absence of microscopic disease at the margin. The bladder is then closed in the usual manner with two-layer closure and standard pelvic lymphadenectomy (including the external iliac and obturator nodes) is performed.

Bottom Line: The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088).Overall, disease-specific and disease-free survival rates were similar.Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.

ABSTRACT

Background: Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder.

Methods: During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy.

Results: Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar.

Conclusion: The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

No MeSH data available.


Related in: MedlinePlus