Category: Laparoscopic/ Robotic: Bladder
Introduction & Objective :
The increasing demand for major surgery in high-risk patients requires a new interdisciplinary approach, based on scientific evidence that allows us to implant perioperative measures and strategies, intended for patients who are going to be subjected to Radical cystectomy with intestinal substitution. In order to reduce the stress secondary to surgery, and achieve a prompt recovery and reduce morbidity and mortality.
According to the guidelines, the treatment of the bladder infiltrating tumours is the radical cystectomy with extended pelvic lymphadenectomy, this technique has a morbidity of 50%: infection, paralytic ileus, fistulas, with a high mortality. We present a laparoscopic mixed technique to allow this treatment in non robotics hospitals
Inclusion criteria: Radical cystectomy, Age: 18-80 years, adequate cognitive status.
Preoperative performance: Optimization of chronic pathology. Optimization of the functional State: rehabilitation. Optimization of nutritional status. Optimization of the emotional state.
Intra-operative action: intake of carbonated fluids two hours before, no intestinal preparation, no central route, no nasogastric tube, fluid restriction and patient warming. Radical Cistoprostatectomy with laparoscopic lymphadenectomy, Enterocistoplasty with Alexis retractor and laparoscopic urethrointestinal anastomosis.
Postoperative action: Restrictive fluid Therapy, early tolerance, early mobilization.
High-10 day criteria: Absence of fever, complications, pain; Wandering and complete intake.
Compliance preoperative protocol: 95%.
Surgical Time: 480 min, bleeding 150 ml, non-transfusion, non-parenteral. Fluid intake 48 hours, total intake 6 days. Early mobilization 24 hours, full ambulation 7 days.
Hospital delivery Ten days
The multidisciplinary interaction added to a less aggressive surgical technique, allows in the case of the cystectomy, a rapid functional recovery of the patient, decrease the average stay, morbidity and mortality and costs. In a hospital without the chance to have a Davinci.
Conde redondo Consuelo– Urologist, Valladolid, Castilla y Leon, Spain
Castroviejo Fatima– urologist, Valladolid, Castilla y Leon, Spain
Alonso Villalba Antonio– uroloist, Valladolid, Castilla y Leon, Spain
Garcia Viña Alejandro– urologist, Valladolid, Castilla y Leon, Spain
Goncalez Montesinos Marta– Urologist, valladolid, Castilla y Leon, Spain
Amon Sesmero Jose– urologist, Valladolid, Castilla y Leon, Spain