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Inicio Actas Urológicas Españolas (English Edition) Laparoendoscopic radical cystectomy with orthotopic ileal neobladder through umb...
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Vol. 36. Issue 9.
Pages 554-561 (October 2012)
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Vol. 36. Issue 9.
Pages 554-561 (October 2012)
Surgical technique
Laparoendoscopic radical cystectomy with orthotopic ileal neobladder through umbilical single port
Cistectomía radical laparoendoscópica con neovejiga íleal ortotópica a través de puerto único umbilical
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1853
J.C. Angulo
Corresponding author
jangulo.hugf@salud.madrid.org

Corresponding author.
, F. Cáceres, I. Arance, I. Romero, F. Ramón de Fata, P.M. Cabrera
Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Servicio Madrileño de Salud, Universidad Europea de Madrid, Madrid, Spain
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Table 1. LESS radical cystectomies published so far by different groups of authors (2009–2012).
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Abstract
Context

Radical cystectomy with orthotopic derivation is one of the most complex urological techniques, although laparoscopic surgery has made this procedure increasingly less invasive.

Objective

To provide an updated review of the single port approach to carry out radical surgery due to bladder cancer.

Evidence acquisition

A comprehensive review of the literature was performed using Medline and Embase to discover the accumulated experience of the viability of carrying out laparoendoscopic radical cystectomy, pelvic lymphadenectomy and orthotopic neobladder using the LESS (laparoendoscopic single site surgery) approach. Our experience with this approach is also presented and the technique used with the reusable KeyPort® system developed by Richard Wolf is described.

Evidence synthesis

Radical treatment of bladder cancer is possible in men and women using a single port and even performance of ileal neobladder, as reconstructive procedure in these patients. The surgical technique, post-operative cares and result obtained in our center are described. The accumulated experience worldwide describes 25 cases of radical cystectomy performed using different single port systems, 14 of them with orthotopic intestinal neobladder.

Conclusion

The KeyPort® umbilical cystectomy constitutes in our setting the least possible invasive alternative to efficiently treat muscle-invasive bladder cancer, with excellent esthetic result, minimum post-operative pain and short hospital stay. The umbilical scar decreases the analgesic requirements and it ends up being practically invisible. This supposes an important step in the development of the minimally invasive surgery for bladder cancer.

Keywords:
LESS
KeyPort®
Radical cystectomy
E-NOTES
Resumen
Contexto

La cistectomía radical con derivación ortotópica es una de las técnicas urológicas más complejas, aunque la cirugía laparoscópica ha hecho posible que este procedimiento sea cada vez menos invasivo.

Objetivo

Proporcionar una revisión actualizada acerca del abordaje a través de puerto único para llevar a cabo cirugía radical por cáncer de vejiga.

Adquisición de evidencia

Se lleva a cabo una revisión exhaustiva de la literatura mediante Medline y Embase para conocer la experiencia acumulada acerca de la viabilidad de llevar a cabo cistectomía radical laparoscópica, linfadenectomía pélvica y neovejiga ortotópica mediante abordaje LESS (laparoendoscopic single site surgery). Se presenta además nuestra experiencia con este abordaje y se describe la técnica empleada con sistema KeyPort® reutilizable, desarrollado por Richard Wolf.

Síntesis de evidencia

Es posible llevar a cabo el tratamiento radical del cáncer de vejiga en hombres y en mujeres a través de puerto único, e incluso la realización de neovejiga ileal como procedimiento reconstructivo en estos pacientes. Se detalla la técnica quirúrgica, los cuidados postoperatorios y el resultado obtenido en nuestro centro. La experiencia acumulada a nivel mundial describe 25 casos de cistectomía radical realizados mediante diferentes sistemas de puerto único, 14 de ellos completados con neovejiga intestinal ortotópica.

Conclusión

La cistectomía KeyPort® umbilical constituye en nuestro entorno la alternativa menos invasiva posible para tratar eficientemente el cáncer de vejiga músculo-invasivo, con excelente resultado estético, mínimo dolor postoperatorio y corta estancia hospitalaria. La cicatriz umbilical disminuye los requerimientos analgésicos y acaba siendo prácticamente invisible, por lo que supone un paso importante en el desarrollo de la cirugía mínimamente invasiva para el cáncer vesical.

Palabras clave:
LESS
KeyPort®
Cistectomía radical
E-NOTES

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