Category: Laparoscopic/ Robotic: Bladder
Introduction & Objective :
Treatment of infiltrating bladder tumor with bladder neck involvement is radical cystectomy with UretHrectomY. In women is a pathology much more rare than in the male. In this video we present the laparoscopic surgery technique step by step
Placement of the patient in Trendelemburg forced with legs in half-opened leg for urethral access. Positioning of the trocars in fan, placing the camera two fingers above the navel to facilitate access to the iliac common in the lymphadenectomy. 2 Trocars of 10 and 3 of 5 are placed.
We start the surgery by fixing and suspending the uterus. We release the infundibulum-pelvic ligaments. Then before starting the Linfadectomy we release and section the ureter to avoid accidents. We performed a bilateral extended linfadenecomy, extracting the ganglia in separate pouches. We pass the left ureter in retrosigma, after performing presacral lalinfadenectomy if necessary. We open the n the bottom of the sack of Douglas, we identified the vagina at the height of the snout of Tench, we access to the anterior vaginal face, section the bladder pedicles until reaching the urethra. This is released longitudinally, until it is inserted into the urethral meatus, which is released from external genitalia. Finally we introduce a bag of extraction by vagina. The surgery ends with the vaginal closure with continuous suture and suspension of the vaginal dome to the Uterosacres ligaments
Surgical time: 240 minutes. Bleeding: 200 ml. Transfusion No.
Laparoscopic radical cystectomy with urethrectomy in women is not very common, it can be performed entirely by laparoscopic means, with extraction of the piece by vaginal way preserving the integrity of the wall. Posterior reconstruction can be performed intracorporeally when there is laparoscopic D or Robot, which facilitates the pure laparoscopic technique without firing the surgical times
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