Laparoscopic radical cystectomy with ileal conduit diversion: the first case report in Thailand.

OBJECTIVE: To report the authors' first experience on a surgical technique for laparoscopic radical cystectomy with ileal conduit diversion. MATERIAL AND METHOD: A 55 year-old man, weighing 65 Kg with histology proven T 2 transitional cell carcinoma of the urinary bladder underwent laparoscopic radical cystectomy with ileal conduit diversion. The cystoprostatectomy was performed by laparoscopic technique, whereas ileal conduit and stroma were performed through a mini-laparotomy. RESULTS: The procedure was performed successfully without open conversion. The operation time was 350 min. Estimated blood loss was 1,100 ml. Only 6 mg morphine was needed for postoperative pain relief. The surgical margins were free from tumor. The hospital stay was 8 days. The patient returned to his normal activities 3 weeks after surgery. CONCLUSION: Laparoscopic radical cystectomy with ileal conduit diversion was a feasible and safe operation for muscle invasive carcinoma of the urinary bladder. However, the procedure needed a steep learning curve and should be performed in centers having experience in laparoscopic surgery.

Laparoscopic renal surgery: Ramathibodi Hospital experience.

OBJECTIVE: To report the authors' early experience of laparoscopic renal surgery for benign and malignant renal conditions. MATERIAL AND METHOD: Laparoscopic renal surgery was performed on 24 patients with benign and malignant renal conditions between July 2004 and February 2005. The patient characteristics and perioperative data including operative time, blood loss, analgesic requirement, complications, duration of postoperative drain removal, length of hospital stay, and duration to return to normal activity were all recorded. RESULTS: Laparoscopic simple nephrectomy was performed in 15 patients with nonfunctioning benign renal conditions. Three operations of hand-assisted laparoscopic radical nephrectomy and one of partial nephrectomy were performed for large and small renal cell carcinoma, respectively. Transitional cell carcinomas were managed by retroperitoneoscopic nephrectomy or hand-assisted approach in 3 cases. For a case of severe inflammatory renal condition, hand-assisted approach was used for treatment. Laparoscopic renal cyst decortication was performed in one case. In the laparoscopic simple nephrectomy group, the mean operative time was 126 +/- 38.3 minutes. The median (range) estimated blood loss was 100 (50-500) mL, and one patient required conversion to open surgery because of renal vein injury. In three cases of hand-assisted laparoscopic radical nephrectomy, the operation time was 315, 325 and 150 minutes and the operative blood loss was 500, 1000 and 200 ml, respectively. In cases of hand-assisted laparoscopic partial nephrectomy, the operation time and the operative blood loss were 220 minutes and 350 ml, respectively. In three cases of transitional cell carcinoma, the operation time was 120, 140 and 150 minutes and the operative blood loss was 100, 150 and 150 ml. The surgical margins of all resected specimens for malignant tumors were negative and no major complication was recorded Simple renal cyst decortication was successfully performed within 90 minutes of operation time and bleeding 50 ml. In cases of severe inflammatory renal condition performed by hand-assisted approach, the operative time was 250 minutes and the operative blood loss was 250 ml. CONCLUSION: Laparoscopic renal surgery is a safe and efficacious approach for resection of benign nonfunctioning kidneys and malignant renal tumors.