Wadhwa Pankaj, Kolla Surendra B, Hemal Ashok K
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Urology. 2006 Apr;67(4):837-43. doi: 10.1016/j.urology.2005.10.048.
Surgical options for treating urachal adenocarcinoma include radical cystectomy and en bloc partial cystectomy with excision of the urachus and umbilectomy. Recently, laparoscopy has been increasingly used to treat bladder and urachal pathologic findings efficaciously. We describe two techniques for performing laparoscopic en bloc partial cystectomy with bilateral extended pelvic lymphadenectomy.
We performed the procedure in 3 patients with established urachal adenocarcinoma. The anatomic boundaries of resection were similar to those described for open surgery. We used an inverted V-shaped, five-port configuration, with the camera port placed 3 cm supraumbilically. An antegrade approach was performed for tumors less than 5 cm in 2 cases. The steps of the procedure included an inverted V-shaped incision along the peritoneum lateral to the medial umbilical ligament on either side; urachal disconnection, dissection of the urachus using the "twist and roll technique"; anterior cystotomy, circumferential resection of the tumor-bearing bladder dome, under vision; tumor placement in a "lap-bag"; bladder reconstruction using intracorporeal suturing; bilateral extended pelvic lymphadenectomy; placement of catheter and drain; and specimen retrieval. We evolved a retrograde technique for larger size tumors (larger than 5 cm). The procedure was successfully completed in all patients, with a mean operative time of 180 minutes (range 150 to 210). No significant intraoperative or postoperative complications occurred, except for a left inferior epigastric artery injury in 1 case. The resected nodes (range 8 to 11) were free of tumor. No local or distant recurrences were observed at a mean follow-up of 6.5 months (range 4.5 to 9).
Laparoscopic en bloc partial cystectomy and bilateral extended pelvic lymphadenectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for urachal tumors.
治疗脐尿管腺癌的手术选择包括根治性膀胱切除术以及整块部分膀胱切除术并切除脐尿管和脐切除术。近来，腹腔镜已越来越多地被有效用于治疗膀胱和脐尿管病变。我们描述两种实施腹腔镜整块部分膀胱切除术并双侧扩大盆腔淋巴结清扫术的技术。
我们对3例确诊的脐尿管腺癌患者实施了该手术。切除的解剖边界与开放手术所描述的相似。我们采用倒V形五孔配置，摄像孔位于脐上3 cm处。2例肿瘤小于5 cm的患者采用顺行入路。手术步骤包括在两侧脐内侧韧带外侧沿腹膜做倒V形切口；离断脐尿管，采用“扭转和滚动技术”游离脐尿管；膀胱前壁切开，在直视下环形切除含肿瘤的膀胱顶部；将肿瘤放入“腹腔镜袋”；采用体内缝合重建膀胱；双侧扩大盆腔淋巴结清扫术；放置导管和引流管；以及取出标本。对于较大尺寸的肿瘤（大于5 cm），我们改进了逆行技术。所有患者手术均成功完成，平均手术时间为180分钟（范围150至210分钟）。除1例左腹壁下动脉损伤外，未发生明显的术中或术后并发症。切除的淋巴结（范围8至11个）无肿瘤。平均随访6.5个月（范围4.5至9个月）未观察到局部或远处复发。
腹腔镜整块部分膀胱切除术和双侧扩大盆腔淋巴结清扫术是治疗脐尿管肿瘤的一种安全、可行、微创的替代开放部分膀胱切除术的方法。
