COMPLICATIONS OF MINIMALLY INVASIVE RADICAL
CYSTECTOMY
Rene Sotelo*, Caracas, Venezuela, Erik Castle, Phoenix, AZ,
Octavio Castillo, Providencia, Chile, Camilo Giedelman, Matteo
Spinelli, Jose Saavedra, Robert De Andrade, Oswaldo Carmona,
Caracas, Venezuela, David Canes, Boston, MA, Carlos Rodriguez,
Caracas, Venezuela
INTRODUCTION AND OBJECTIVES: Open Radical Cystectomy is
the standard treatment for high grade and muscle invasive bladder
cancer, with the significant potential of early complications even in
the most experienced hands and in high volume center. Over the
last decade, we have witnessed the emergence and progression of
minimally invasive surgery in urology including radical cystectomy.
Any new technique applied to the treatment of invasive bladder
cancer must be safe, maintain similar oncological principles as
ORC, and provide similar options for lower urinary tract
reconstruction. While many complications of radical cystectomy are
shared between approaches, recognition and management in the
robotic and laparoscopic surgery environment poses unique
challenges. The goal of this video is to present graphic illustrations
of complications during robotic or laparoscopic radical cystectomy.
METHODS: A multi-institutional collection of surgical videos was
compiled. These videos illustrate vascular injury, rectal injury,
benign ureteral strictures and the presence of vesicovaginal fistula
after surgery. Management techniques are illustrated where
appropriate.
RESULTS: This video shows the possible complications and how
often they are encountered, comparing the different approaches,
open, laparoscopic and robotic. In addition, short and middle term
complications in patient after Minimally invasive Radical Cystectomy
are characterized.
CONCLUSIONS: RARC and LRC must reproduce the robust
oncological outcomes seen with ORC while attempting to minimize
perioperative morbidity.
RARC and LRC incurs acceptably low postoperative morbidity, with
the vast majority of complications being low grade. High-grade
complications are infrequent and similar to those encountered after
ORC. Complications are similar in all approaches, but may be
surgeon or technique related. Early recognition and appropriate
management is essential when these complications occur.
Source of Funding: none
InstitutionUnidad de Urologia, Inst. Méd. La Floresta, Caracas, Venezuela
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