The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy
강승철, 강성구, 고영휘, 이정구, 김제종, 강석호, 전준,
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강승철 ( Kang Seung-Chul )
고려대학교 의과대학 비뇨기과학교실
강성구 ( Kang Sung-Gu )
고려대학교 의과대학 비뇨기과학교실
고영휘 ( Ko Young-Hwii )
고려대학교 의과대학 비뇨기과학교실
이정구 ( Lee Jeong-Gu )
고려대학교 의과대학 비뇨기과학교실
김제종 ( Kim Je-Jong )
고려대학교 의과대학 비뇨기과학교실
강석호 ( Kang Seok-Ho )
고려대학교 의과대학 비뇨기과학교실
전준 ( Cheon Jun )
고려대학교 의과대학 비뇨기과학교실
KMID : 0358320090500090870
Abstract
Purpose: We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique.
Materials and Methods: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained.
Results: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5±145.1 minutes, and the mean estimated blood loss was 346.8±205.9 ml. The mean time for PLND was 106.7±25.2 minutes in patients with ePLND and 72.1±14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23.5±12.8 (range, 8-50) in all patients: 38.6±10.8 (range, 29-50) in ePLND and 15.7±12.2 (range, 8-21) in sPLND.
Conclusions: Perioperative data and oncologic features showed that RARC with PLND is feasible. Robot-assisted laparoscopic surgery is a safe and effective procedure with acceptable morbidity and good oncologic results from the viewpoint of PLND, especially ePLND.
키워드
Urinary bladder neoplasms;Lymphadenectomy;Robotics;Cystectomy;Laparoscopy
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