ABSTRACT

Objectives:

Laparoscopic Radical Cystectomy (LRC) is gaining increasing interest at many centers worldwide and the number of cases performed is steadily increasing. In this review, the worldwide experience on LRC, techniques and oncological outcomes are evaluated and discussed.

Methods:

The English-language literature on LRC published to today was reviewed in the National Library of Medicine (USA) database. More than 100 papers were identified and 38 of them were selected to form this review. Papers were then further classified to form the chapters that were mainly history, techniques, perioperative/pathological outcomes and oncological outcomes.

Results:

LRC seems to achieve all the surgical goals as open radical cystectomy (ORC). The LRD operative technique is more standardized and the perioperative parameters are comparable to ORC, and even better in terms of hospital stay, postperative pain, estimated blood loss and return of bowel functions. The most implemented and successful diversion technique is an ileal loop conduit or an orthotopic neobladder performed extracorporeally through a mini-laparotomy which is also used for organ retrieval. Totally laparoscopic (intracorporeal) diversion technique seems to be abandoned due to high rate of complications. Although short and intermediate oncological results of LRC seems to be comparable to ORC, the number of patients in each published series is still small and the follow-op time is relatively short. The discrepancy between the laparoscopic and open series in pathological outcomes is worth attention and this may influence the future oncological outcomes to come in the following years. The long-term oncological results of LRC are needed for an accurate comparison with the open radical cystectomy, which still seems to be the standard treatment in muscle invasive bladder cancer.

Conclusions:

LRC is an important step in urooncological surgery towards a more minimally-invasive technique. It is accepted worldwide and performed at many centers in many countries. It seems to be a less morbid surgery compared to ORC. The short and intermediate term pathological results of LRC seem to be encouraging, but the long term results are not in hand for a better and accurate comparison.