Laparoscopic urologic surgery in malignancies - part 1 pdf

de la RosetteAcademic Medical Center Section ofLaparoscopic and Minimally Invasive Surgery Glickman Urological Institute, A 100 Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland,

Laparoscopic Urologic Surgery in Malignancies

Jean J.M.C.H de la Rosette ´ Inderbir S Gill Editors

Professor Dr Jean J.M.C.H de la Rosette

Academic Medical Center

Section ofLaparoscopic and Minimally Invasive Surgery

Glickman Urological Institute, A 100

Cleveland Clinic Foundation

9500 Euclid Avenue

Cleveland, OH 44195

USA

ISBN-10 3-540-20512-8 Springer Berlin Heidelberg New York

ISBN-13 978-3-540-20512-8 Springer Berlin Heidelberg New York

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The era ofendo-oncology has arrived Endo-oncology is now firmly trenched in the diagnosis and management ofurologic cancers From its earlydays with transurethral resection ofbladder tumors, to the more recent de-cades with establishment oftechniques for percutaneous resection oftransi-tional cell carcinoma, endo-oncology is the endoscopic treatment ofcancer.More recently, the application oflaparoscopy to the treatment ofurologic can-cers has continued the tradition Laparoscopy has expanded and evolved from

en-a dien-agnostic moden-ality with len-apen-aroscopic pelvic lymphen-adenectomy for prosten-atecancer to include radical therapy for surgical management of every abdominalorgan in the genitourinary system

This textbook is important for many reasons The integration of oncologictherapeutic intervention with a minimally invasive modality must bear thescrutiny ofdirect comparison with open surgery in terms ofactuarial survivalstatistics and functional results Laparoscopic radical nephrectomy for renalcell carcinoma has withstood the test oftime in terms ofdisease-free survival,blood loss, postoperative discomfort, tumor port site implantation, hospitalstay and convalescence For other procedures, we look to achieve the samestandards

The advance oflaparoscopy into the realm ofoncologic surgery has alsochallenged individuals who perform open surgery to re-examine their practice

in order to improve their functional results The challenge to improve themorbidity ofany procedure is to the ultimate benefit ofour patients

Just as there are multiple ways to cook in the kitchen, there are numeroustechniques for laparoscopic radical prostatectomy From a transperitonealapproach to an extraperitoneal approach, to subtle changes in addressing theseminal vesicles and vas deferens, vesical±urethral anastomosis or port place-ment, the optimal method continues to evolve Significantly less blood lossand earlier achievement ofurinary continence are proven benefits ofthis pro-cedure With the learning curve, recognition of earlier difficulties have led tomodifications that are reducing margin-positive rates to the standards set byopen radical retropubic prostatectomy We look forward to reviewing long-term ofPSA follow-up and survival statistics with which vigilant surveillancewill prove the true efficacy of this procedure

Foreword

Endo-oncology, with a natural extension to include laparoscopy, has beenseeded into the roots ofsurgical practice and training ofurologists world-wide We look forward to the fruit that will continue to spring forth from theeducation and dissemination ofthis information.

Benjamin R Lee, MD

Director, Laparoscopy Section, Assistant Professor of Urology,

Long Island Jewish Medical Center

Arthur D Smith, MD

President, Endourology Society

VI Foreword

Long adept at sophisticated endourologic techniques that exclusively addressthe intraluminal aspects ofthe urinary tract, urologic surgeons are now em-bracing laparoscopic techniques which, like open surgery, address the extra-luminal aspect ofthe genitourinary system In tandem, endourology and lapa-roscopy complete the spectrum ofminimally invasive urology.

The horizons oflaparoscopic surgery are expanding, such that the whelming majority ofabdominal urologic procedures have now been per-formed laparoscopically In some of these procedures the laparoscopic alter-native has been demonstrated to be superior to its open counterpart, inothers comparative analyses are currently ongoing, and in yet others only theinitial forays of minimally invasive surgery have yet been undertaken

over-Change must not be embraced just because it is different, or new Thetried and trusted must not be cast aside until its novel replacement has un-dergone an honest, duly diligent evaluation Following this dictum, laparo-scopy is being gradually incorporated into mainstream urology, with appro-priate caution and healthy, constructive critique

Clinical advances ofany significance cannot occur in isolation As regardslaparoscopic urology, minimally invasive surgeons must join forces with theiropen surgical colleagues, so as to advance the field together Free discussionand close collaboration are necessary to ensure that long-established surgicalprinciples are adhered to, and outcomes are evaluated critically on an ongoingbasis Only by fulfilling its promise of being ªminimally invasive ± maximallyeffectiveº, will laparoscopic urology truly enter the mainstream It is our be-liefthat laparoscopy is likely to have a far-reaching impact on our field.This book is an effort towards compiling the current body of knowledge inlaparoscopic urology under one cover The various authors, respected experts

in the field, have provided concise updates on their respective topics We aredeeply indebted to them for their thoughtful contributions We hope that theinformation contained in this book will help interested urologists to advancetheir laparoscopic knowledge and skill set

Jean J.M.C.H de la Rosette, PhD, MD

Inderbir S Gill, MD, MCh

Preface

2 Renal Cell Carcinoma I

2.1Transperitoneal Radical Nephrectomy 19Alwin F Tan, Adrian D Joyce

2.2 Extraperitoneal Laparoscopic Radical Nephrectomy 29Andr—s Hoznek, Laurent Salomon, Clment-Claude Abbou

2.3 Hand-Assisted Laparoscopic Nephrectomy 39Franœois Rozet, Declan Cahill, Franœois Desgrandchamps

3 Renal Cell Carcinoma II

3.1Laparoscopic Partial Nephrectomy 49Antonio Finelli, Inderbir S Gill

3.2 Cryoablation and Other Invasive

and Noninvasive Ablative Renal Procedures 59Patrick S Lowry, Stephen Y Nakada

4 Laparoscopic Radical Nephroureterectomy

for Upper Tract Transitional Cell Carcinoma 71Juan Palou, Antonio Rosales, Nico De Graeve,

Humberto Villavicencio

5 Bladder Cancer

5.1Laparoscopic Radical Cystectomy and Intracorporeal

Constructed Sigma Rectum-Pouch (Mainz Pouch II) 89IngolfTuerk

5.2 Laparoscopic Radical Cystectomy

with Orthotopic Bladder Replacement 97Roland F van Velthoven, Jens Rassweiler

Contents

6 Prostate

6.1Laparoscopic Pelvic Lymph Node Dissection 117BrunolfW Lagerveld, Jean J.M.C.H de la Rosette

6.2 Extraperitoneal Laparoscopic Radical Prostatectomy:

The Brussels Technique 133Renaud Bollens, Sarb Sandhu, Thierry Roumeguere,

Claude Schulman

6.3 Laparoscopic Radical Prostatectomy:

The Transperitoneal Antegrade Approach 141Karim Touijer, Edouard Trabulsi, Waleed Hassen,

Bertrand Guillonneau

6.4 The Laparoscopic Radical Prostatovesiculectomy ±

Transperitoneal Access 149Thomas Frede, Michael Schulze, Reinaldo Marrero,

Ahmed Hammady, Dogu Teber, Jens Rassweiler

6.5 Robotic Radical Prostatectomy: Surgical Technique 163Mani Menon, Michael J Fumo, Ashok K Hemal

6.6 Extraperitoneal Versus Transperitoneal Laparoscopic

Radical Prostatectomy 177Franœois Rozet, Carlos Arroyo, Xavier Cathelineau, Eric Barret,

Guy Vallancien

6.7 Handling Complications in Laparoscopic

Radical Prostatectomy 185Luis MartÌnez-Piµeiro, Hanna Prez-Chrzanowska,

Jorge Serra Gonz—lez, JesÙs J de la Peµa

7 Laparoscopic Retroperitoneal Lymph Node Dissection

for Testicular Tumors 201Gunther Janetschek

8 Morcellation or Intact Extraction in Laparoscopic Radical

Nephrectomy 213Yoshinari Ono, Yohei Hattori

9 Focusing Our Attention on Trocar Seeding! 221Giampaolo Bianchi, Salvatore Micali, Antonio Celia, Adara Caruso,Guglielmo Breda

11 Training in Laparoscopy 253Maria P Laguna, Hessel Wijkstra, Jean J.M.C.H de la Rosette

X Contents

12 Laparoscopic Instrumentation 271Monish Aron, Mihir M Desai, Mauricio Rubinstein, Inderbir S Gill

13 Anaesthesia for Laparoscopic Urologic Surgery

in Malignancies 287Christian P Henny, Jan Hofland

14 The Future of Laparoscopic Surgery in Urologic Malignancies 301Michael Marberger

Clment-Claude Abbou, MD

Service d'Urologie

Centre Hospitalier Universitaire Henri Mondor

51 Av du Marchal de Lattre de Tassigny

94010 Crteil Cedex, France

Department ofUrology and Nephrology

Institute Mutualiste Montsouris

42 Boulevard Jourdan

75014 Paris, France

Simon V Bariol, MB BS, BSc

The Scottish Lithotriptor Centre

Western General Hospital

Crewe Road

Edinburgh, EH4 2XU, UK

Eric Barret, MD

Department ofUrology and Nephrology

Institute Mutualiste Montsouris

Department ofUrology and Nephrology

Institute Mutualiste Montsouris

Department ofUrology and Nephrology

Institute Mutualiste Montsouris

Universit™ Vita e Salute

San Raffaele Hospital

Milan, Italy

Hanna Prez-Chrzanowska, MB, BS

Department ofAnaesthesia and Critical Care

La Paz University Hospital

Jorge Serra Gonz—lez, MD

Department ofAnaesthesia and Critical Care

La Paz University HospitalMadrid, Spain

Nico De Graeve, MD

Department ofUrologyFundaciÕ PuigvertUniversitat Autonoma de Barcelona

08025 Barcelona, Spain

Giorgio Guazzoni, MD

Department ofUrologyUniversit™ Vita e SaluteSan Raffaele HospitalMilan, Italy

Bertrand Guillonneau, MD

Memorial Sloan Kettering Cancer CenterSidney Kimmel Center for Prostate and Urologic Cancers

353 East 68th StreetNew York, NY 10021, USA

Ahmed Hammady, MD

Department ofUrologySLK Kliniken Heilbronn

Am Gesundbrunnen 20

74078 Heilbronn, Germany

Waleed Hassen, MD

Memorial Sloan Kettering Cancer Center

Sidney Kimmel Center for Prostate and Urologic Cancers

Ashok K Hemal, MD, MCh, FACS

Vattikuti Urology Institute

Henry Ford Hospital

2799 West Grand Boulevard

Centre Hospitalier Universitaire Henri Mondor

51 Av du Marchal de Lattre de Tassigny

94010 Crteil Cedex, France

Stephen C Jacobs, MD

Divisions ofUrology and Videoscopic Surgery

Department ofSurgery

University ofMaryland School ofMedicine

Baltimore, Maryland, USA

Pyrah Department ofUrology

St James University Hospital

Leeds, UK

XVI List of Contributors

Jihad H Kaouk, MD

The Cleveland Clinic FoundationGlickman Urological InstituteSection ofLaparoscopic and Minimally Invasive Surgery

9500 Euclid AvenueCleveland, OH 44195, USA

Brunolf W Lagerveld, MD

Department ofUrologyAMC University HospitalMeibergdreef9

Amsterdam, The Netherlands

Maria P Laguna, MD, PhD

Department ofUrologyAMC University HospitalMeibergdreef9

Amsterdam, The Netherlands

Michael Marberger, MD, FRCS

Department ofUrologyUniversity ofVienna Medical SchoolWåhringer Gçrtel 18±20

1090 Vienna, Austria

Reinaldo Marrero, MD

Department ofUrologySLK Kliniken Heilbronn

Am Gesundbrunnen 20

74078 Heilbronn, Germany

Mani Menon, MD, FACS

DirectorVattikuti Urology InstituteHenry Ford Hospital

2799 West Grand BoulevardDetroit, MI 48202, USA

Universit™ Vita e Salute

San Raffaele Hospital

Universit™ Vita e Salute

San Raffaele Hospital

Milan, Italy

XVIII List of Contributors

Antonio Rosales, MD

Department ofUrologyFundaciÕ PuigvertUniversitat Autonoma de Barcelona

08025 Barcelona, Spain

Jean J M.C.H de la Rosette, MD, PhD

Department ofUrologyAMC University HospitalMeibergdreef9

Amsterdam, The Netherlands

Thierry Roumeguere, MD

Department ofUrologyUniversity Clinics BrusselsErasme HÖpital

Laurent Salomon, MD

Service d'UrologieCentre Hospitalier Universitaire Henri Mondor

51 Av du Marchal de Lattre de Tassigny

94010 Crteil Cedex, France

Sarb Sandhu, BSc (Hons), FRCS

Department ofUrologyUniversity Clinics BrusselsErasme HÖpital

Route de Lennik 808

1070 Brussels, Belgium

Claude Schulman, MD, PhD

Department ofUrologyUniversity Clinics BrusselsErasme HÖpital

Route de Lennik 808

1070 Brussels, Belgium

Pyrah Department ofUrology

St James University Hospital

David A Tolley, MB BS, FRCP Ed, FRCS, FRCS Ed

The Scottish Lithotriptor Centre

Western General Hospital

Crewe Road

Edinburgh, EH4 2XU, UK

Karim A Touijer, MD

Memorial Sloan Kettering Cancer Center

Sidney Kimmel Center for Prostate and Urologic Cancers

353 East 68th Street

New York, NY 10021, USA

Edouard Trabulsi, MD

Memorial Sloan Kettering Cancer Center

Sidney Kimmel Center for Prostate and Urologic Cancers

353 East 68th Street

New York, NY 10021, USA

Michael C Truss, MD

Department ofUrology and Pediatric Urology

Medizinische Hochschule Hannover

Carl-Neuberg-Strảe 1

30625 Hannover, Germany

XX List of Contributors

Ingolf Tuerk, MD, PhD

Department ofUrologyLahey Clinic

Burlington, MA 01805, USA

Guy Vallancien, MD

Department ofUrologyInstitute Mutualiste Montsouris

42 Boulevard Jourdan

75014 Paris, France

Roland F van Velthoven, MD, PhD

Department ofUrologyInstitut Jules BordetUniversit Libre de BruxellesBrussels, Belgium

Humberto Villavicencio, MD

Department ofUrologyFundaciÕ PuigvertUniversitat Autonoma de Barcelona

08025 Barcelona, Spain

Hessel Wijkstra, MSc, PhD

Department ofUrologyAMC University HospitalMeibergdreef9

Amsterdam, The Netherlands

1Adrenal Cancer

Since its first description by Gagner et al [1],

laparo-scopic adrenalectomy has gained in popularity within

the urological community, and it is presently

consid-ered to be the gold standard in the treatment

ofbe-nign adrenal lesions [2, 3]

Though there appears to be worldwide consensus

for the use oflaparoscopy in the treatment ofbenign

functional and nonfunctional adrenal pathologies

(even though the tumor may be large in diameter and

possibly benign, as shown by Henry et al [4] and

Karazayan et al [5]), several concerns and

controver-sies have arisen regarding the efficacy and

effective-ness oflaparoscopic adrenalectomy in malignancies,

either primary or metastatic

Following the pioneering report by Elashry et al

[6] on the feasibility of laparoscopic adrenalectomy in

malignancies (namely two cases ofadrenalectomy for

solitary, contralateral adrenal metastasis from renal

cell carcinoma), the number ofpublications dealing

with the removal ofneoplastic or metastatic adrenal

lesions by laparoscopy has increased progressively

However, data regarding the results oflaparoscopic

adrenalectomy in malignancies are still limited mainly

to case reports or small cohort studies, with short

fol-low-ups

Details regarding the feasibility of laparoscopic

rad-ical adrenalectomy have already been reported, while

both the oncological efficacy and potential risks

re-lated to laparoscopy in treatment ofthis kind lignancy should be properly assessed in the future

ofma-Indications and Contraindications

Although the precise role oflaparoscopic ctomy in malignant lesions is still controversial, ananalysis ofavailable literature and our own personalexperience [7] indicate that this procedure appears to

adrenale-be gradually gaining acceptance

Laparoscopic adrenalectomy in malignancies can

be performed both in cases of primary adrenal nant tumors as well as in cases ofmetastatic lesions.Conditions for laparoscopic adrenalectomy in caseofa malignancy are considered plausible ifthe lesionappears to be organ-confined, with no evidence of lo-cal invasion and neoplastic involvement ofthe adrenalvein [8, 9]

malig-Taking into account the highly malignant teristics ofprimary adrenal carcinomas (having astrong tendency towards local invasion and metastaticdiffusion) and the goal of a laparoscopic surgical pro-cedure (adequate oncological, surgical margins withwide excision), it is suggested that lesions greater than6±7 cm may render the laparoscopic adrenalectomy anonradical procedure

charac-In a metastatic disease, ifthe lesion appears to besolitary and organ-confined, the procedure could re-sult in prolonged, disease-free patient survival [10].Indications for laparoscopic adrenalectomy in meta-static lesions include:

n Curative reasons, in solitary adrenal metastasis

n Diagnostic purposes, in suspected adrenal sis

metasta-Contraindications for transperitoneal laparoscopicadrenalectomy in malignancies can be divided into:contraindications to laparoscopy in general such as se-

1.1 Transperitoneal Laparoscopic Adrenalectomy in Malignancies

Giorgio Guazzoni, Andrea Cestari, Francesco Montorsi,Patrizio Rigatti