In 2001, Cleveland Clinic's Glickman Urological Institute performed the world's first laparoscopic radical cystoprostatectomy with intracorporeal urinary diversion (ileal conduit or orthotopic neobladder). Since then, over 15 patients have undergone this procedure successfully. Developed by a Clinic urologist, our team first refined this technique in the laboratory and now offers the procedure for patients.
We are able to precisely duplicate all the necessary ablative and reconstructive technical maneuvers laparoscopically, while maintaining established oncologic and reconstructive principles.
The laparoscopic procedure offers several potential advantages over open surgery. In an initial study of our first eight patients, blood loss was only 250 to 450 ml and seven of the eight patients did not require any transfusions. In addition, bowel manipulation was decreased, and there was minimal postoperative pain, resulting in less use of narcotics. Resumption of bowel activity and ambulation occurred early, leading to early discharge. Total operative time has been reduced from 11.5 hours initially to six-and-a-half hours in the more recent cases; the open procedure requires about five hours.
Laparoscopic radical cystoprostatectomy may become an attractive treatment option for selected candidates who have localized muscle-invasive bladder cancer. The procedure is currently restricted to patients with a small-volume bladder cancer without extravesical involvement or pelvic lymphadenopathy on abdominal computed tomography. We are able to construct a neobladder (new bladder) using a segment of small bowel, employing pure laparoscopic techniques exclusively.