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MP-13.10: Achieving Pt0n0 at Radical Cystectomy: Outcomes of 135 Pt0n0 Bladder Cancer Patients Treated with Radical Cystectomy: The Canadian Bladder Cancer Network Experience
MODERATED POSTER SESSIONS
tion, consultation with a specialized nurse, a fixed team of 2 operating urologists, standardized lymph node dissection. 23 patients were prospectively analyzed. An increase in the scores of 17 QI’s was found, of which 8 deviated less than 10% from the norm. Multidisciplinary consultation: preoperative 48%, postoperative 78%. Visit to specialized nurse: pre- and postoperative 83%. Informed consent 100%. In 5 out of 6 waiting periods the norm was achieved. Complication rate did increase (74%), partly explained by prospective registration. Mean number of lymph nodes per dissection increased to 14, positive margins decreased from 23 to 13%. Mortality rate 0%. Conclusions: An extensive set of QI’s for treatment of muscle-invasive bladder cancer has been developed. Retrospectively the QI’s-results were tested against a norm. After making adjustments in treatment protocol, a prospective study showed a higher score reached in 17 QI’s, implying an increase in quality of care. These improvements are partly the result of prospective registration and partly the effect of a better treatment protocol. MP-13.09 Assessment of Morbidity, General Health and Functional Status of the Patients Who Underwent Radical Cystectomy Sharifiaghdas F, Soltani M, Kashi A, Javaherforooshzadeh A, Tajali F Urology and Nephrology Research Center, Shaheed Labbafinejad Hospital, Shaheed Beheshti Medical University, Tehran, Iran Introduction and Objective: We evaluated morbidity, survival, general health and functional status of the patients who underwent radical cystectomy (RC) and Life satisfaction was compared in different group of patients. Patients and Methods: All patients who had undergone RC using different bladder reservoir construction techniques between July 2001 and August 2008 in a referral Iranian urologic center were included. Perioperative and postoperative complications in early (less than 3 months) and late phase were recorded from patients’ hospital records. Telephone interviews were made to assess for patients’ survival, life satisfaction, social status, continence and potency. Results: There were 251 patients (mean age: 62.1 (37-82) years; Male/Female: 24/ 227) studied. Bladder reservoir construction technique was orthotopic neobladder in 155, ileal conduit in 57, continent
pouch (appendix diversion) in 16 and ureterosigmoidostomy in 5 patients, also 18 patients had undergone cutaneous ureterostomy. Repeat exploration was necessary in 55 patients and the most common causes were continuous leakage from abdominal drain or suture line and incisional hernia. Ten patients presented with different types of fistula and 7 patients needed a surgery for its management. During a follow up duration of 6 to 91 months, 57 patients had died and follow up information was available for 62 patients. There was no statistically significant difference for life satisfaction between different types of urinary reservoir reconstruction techniques, but patients with ureterosigmoidostomy had lower overall satisfaction. Dependency rate for personal activity was lower in orthotopic neobladder than other urinary reservoirs. Prostate sparing orthotopic ileal pouch had the highest continency and potency rate. Conclusion: This data from a large number of patients with invasive bladder cancer reveal that the patients experience a high complication rate. It seems that life satisfaction is independent of the type of urinary reservoir but patients’ and their families’ acceptance for orthotopic neobladder is higher. MP-13.10 Achieving Pt0n0 at Radical Cystectomy: Outcomes of 135 Pt0n0 Bladder Cancer Patients Treated with Radical Cystectomy: The Canadian Bladder Cancer Network Experience Drachenberg D1, Aprikian A2, Chin J4, Fradet Y3, Izawa J4, Estey E5, Fairey A5, Rendon R8, Cagiannos I6, Lacombe L3, Lattouf J7, Bell D8, Kassouf W2 1 Department of Surgery (Urology), University of Manitoba, Winnipeg, Canada; 2 Department of Surgery (Urology), McGill University, Montreal, Canada; 3 Department of Surgery (Urology), Universite Laval, Quebec, Canada; 4Department of Surgery (Urology), University of Western Ontario, London, Canada; 5Department of Surgery (Urology), University of Alberta, Edmonton, Canada; 6Department of Surgery (Urology), University of Ottawa, Ottawa, Canada; 7 Department of Surgery (Urology), Universite De Montreal, Montreal, Canada; 8 Department of Surgery (Urology), Dalhousie University, Halifax, Canada Introduction and Objectives: Radical cystectomy is the standard treatment for muscle invasive bladder cancer and is increasingly being offered for treatment of T1G3 disease and in a consolidative ap-
UROLOGY 74 (Supplment 4A), October 2009
proach after treatment with neoadjuvant chemotherapy. This has resulted in a significant number of patients with pT0 pathology after cystectomy. We assessed clinical outcomes in patients found to have no evidence of disease, ie pT0N0, in the cystectomy specimen following radical cystectomy for transitional cell carcinoma. Materials and Methods: We collected and pooled a database of 2287 patients who have underwent radical cystectomy between 1993 and 2008 in 8 different centers across Canada. At time of cystectomy, 135 patients were found to have pT0N0 bladder cancer. Variables analyzed included patient age, clinical stage, nodal status, histologic type, previous history of superficial TCC and CIS, use of neoadjuvant chemotherapy, type of pelvic lymph node dissection (none, standard, extended). Survival data were analyzed using Kaplan-Meier method and Cox proportional regression analysis. Results: Median age of patients was 66 years with a mean follow-up time of 42 months. Clinical stage distribution was Tcis 10%, Ta 2%, T1 24%, T2 52%, T3 6%, T4 5%. There were 24% who had a history of concomitant CIS with 35% of patients with a history of previous superficial TCC. Pelvic lymph node dissection was performed in 94% of patients with 65% following standard template and 35% with extended template. There were 8% of patients who received neoadjuvant chemotherapy prior to cystectomy. The 5-year recurrence-free survival, diseasespecific survival, and overall survival was 83%, 96%, and 88% respectively. The 10year recurrence-free survival, disease-specific survival, and overall survival was 66%, 92%, and 70% respectively. There were 83% of patients with TCC as primary pathology. On Cox proportional regression analysis only patient age correlated to overall survival. Conclusions: These results indicate that the finding of pT0 is a predictor of superior outcomes from cystectomy with a high 5 and 10 year recurrence-free survival, diseasespecific survival, and overall survival. It should be noted however that pT0 is not a guarantee of recurrence free survival as there is still a substantial risk of tumor recurrence in this patient population. With increasing utilization of neoadjuvant chemotherapy prior to cystectomy it is likely that increasing pT0 rates will be encountered and the outcomes of this specific group of patients will need to be independently analyzed. As clinical stage was not a prognostic factor, achieving pT0N0 at cystectomy can be used as a surrogate endpoint for survival
S105
MODERATED POSTER SESSIONS
when evaluating efficacy of neoadjuvant chemotherapy.
MP-13.11 Preoperative Hydronephrosis Predicts Poorer Outcomes after Radical Cystectomy for Invasive Bladder Cancer Lee Y, Kim D, Hong S Department of Urology, Yonsei University College of Medicine, Seoul, South Korea Introduction and Objectives: The prognostic significance of preoperative hydronephrosis after radical cystectomy has been investigated in other studies with conflicting results. We investigated whether the presence and severity of preoperative hydronephrosis has prognostic significance in patients who underwent radical cystectomy for invasive bladder cancer. Materials and Methods: Between 1986 and 2005, medical records of 406 patients who underwent radical cystectomy were reviewed retrospectively. According to the Society for Fetal Urology grading system, patients were divided into low (grade 1 and 2) and high grade (grade 3 and 4) hydronephrosis groups. The clinicopathologic factors associated with preoperative hydronephrosis were evaluated and survival was calculated by KaplanMeier method. Results: Of a total of 406 patients, unilateral hydronephrosis was found in 74 (18.2%) patients, bilateral hydronephrosis in 11 (2.7%), and no hydronephoris in 321 (79.1%). Low grade hydronephrosis was found in 57 (12.2%) patients and high grade hydronephrosis in 28 (6%). Preoperative hydronephrosis was related to higher pT stage, LN invasion, positive surgical margin and higher tumor grade. In univariate analysis, patient age, presence of hydronephrosis, hydronephrosis grade, T stage, N stage, tumor grade, surgical margin, number of retrieved nodes, CIS, and lymphovascular invasion were significant prognostic factors after radical cystectomy. In multivariate analysis, age, bilateral hydronephrosis (HR 7.16), high grade hydronephrosis (HR 2.2), pT stage, LN invasion, positive margin and number of retrieved nodes were significant independent risk factors for cancer specific survival. Conclusions: Bilateral hydronephrosis and high grade hydronephrosis predict poor outcomes after radical cystectomy. Preoperative hydronephrosis could be useful for selecting patients and determining
S106
the efficacy of adjuvant chemotherapy stragegies. MP-13.12 Comparison of Hand Assisted Laparoscopic and Open Radical Cystectomy for Bladder Cancer Chen L1, Wang S1, Zhang Y2, Chen W1, Lin H1 1 Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; 2Department of Urology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, China Introduction and Objective: To present our experience of hand-assisted laparoscopic radical cystectomy (HALRC) and compare it with open radical cystectomy ORC). Materials and Methods: During the period of May 2004 and November 2007, 31 patients underwent HALRC and 39 patients underwent ORC for bladder cancer. The patient demographics, intraoperative variables, postoperative outcomes were compared retrospectively. Results: There was no statistically significant difference with regard to age, sex, body mass index, urinary diversion and tumor stage in the two groups. The HALRC group had decreased blood loss(250.9 vs. 812.8cc, P⬍0.001) and lower rate of transfusion (9.7% vs. 76.9%, P⬍0.001), but similar mean operative time (365.7 vs. 362.6minutes, P⫽0.862).Time to liquid diet was significantly less in the HALRC group vs. the ORC group (4.3 vs. 6.3days, P⬍0.001). The median number of lymph nodes were similar between the HALRC and ORC groups (14 vs.15, P⫽0.377). All margins in both groups were negative.Six patients developed perioperative complications in the HALRC group and 12 patients had complications in the ORC group(19.4% vs. 30.8%, P⫽0.278).Late complications occurred in three patients (two parastomal hernias and one ureteroenteral stricture) in the HALRC group. Conclusions: Compared with ORC, HALRC had decreased blood loss, less transfusion requirements and quicker intestinal recovery than ORC. Long term follow-up in a larger cohort of patients is needed to assess long-term oncological and functional outcomes. MP-13.13 Reducing Intraoperative Blood Loss and Transfusion Requirements during Radical Cystectomy: A Comparative Analysis of Three Different Approaches
Chen L, Wang S, Chen Y, Chen J, Chen W, Lin H Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China Introduction and Objective: To compare intraoperative blood loss and transfusion requirements in patients undergoing radical cystectomy using the clamp-and-tie technique,LigaSure versus hand-assisted laparoscopy. Materials and Methods: Eighty-seven bladder cancer patients were enrolled in this study between January 2003 and October 2007. Patients were divided into 3 groups: radical cystectomy using the clamp-and-tie technique (CLAMP group, n⫽32), radical cystectomy using LigaSure (LigaSure group, n⫽24) and hand-assisted laparoscopic radical cystectomy (HALRC group, n⫽31). The serum hematocrits were obtained preoperatively and 24 hours postoperatively in all patients. The intraoperative blood loss volune and transfusion requirements were recorded. Results: The three groups were similar in age, sex, body mass index, previous abdominal surgeries, the number with anaemia, urinary diversion or tumor stage. The LigaSure group had less blood loss (604.2 vs. 835.9ml,p⬍0.05) and lower transfusion rate (66.7% vs 93.8%,p⬍0.05) than the CLAMP group. Compared with the CLAMP group and LigaSure group, the HALRC group had less blood loss and lower transfusion rate(p⬍0.001). However, the mean perioperative change in hematocrit was not significant in the three groups (P⫽0.87),which indicated that the CLAMP group and LigaSure group had more blood loss and higher transfusion volume than the HALRC group intraoperatively. Conclusions: The use of LigaSure is equally as safe and effective at vessel division and hemostasis as the clamp-and-tie technique, with a statistically significant decrease in blood loss and transfusion rate. Hand assisted laparoscopic radical cystectomy results in decreased blood loss and less transfusion requirements than the two open radical cystectomies. The LigaSure has a good effect in hemostasis, and it is also an effective instrument for separation during laparoscopic radical cystectomy.
MP-13.14 Extended Lymphadenectomy While Radical Cystectomy Managadze G, Khvadagiani G, Managadze L National Center of Urology, Tbilisi, Georgia
UROLOGY 74 (Supplment 4A), October 2009
tion, consultation with a specialized nurse, a fixed team of 2 operating urologists, standardized lymph node dissection. 23 patients were prospectively analyzed. An increase in the scores of 17 QI’s was found, of which 8 deviated less than 10% from the norm. Multidisciplinary consultation: preoperative 48%, postoperative 78%. Visit to specialized nurse: pre- and postoperative 83%. Informed consent 100%. In 5 out of 6 waiting periods the norm was achieved. Complication rate did increase (74%), partly explained by prospective registration. Mean number of lymph nodes per dissection increased to 14, positive margins decreased from 23 to 13%. Mortality rate 0%. Conclusions: An extensive set of QI’s for treatment of muscle-invasive bladder cancer has been developed. Retrospectively the QI’s-results were tested against a norm. After making adjustments in treatment protocol, a prospective study showed a higher score reached in 17 QI’s, implying an increase in quality of care. These improvements are partly the result of prospective registration and partly the effect of a better treatment protocol. MP-13.09 Assessment of Morbidity, General Health and Functional Status of the Patients Who Underwent Radical Cystectomy Sharifiaghdas F, Soltani M, Kashi A, Javaherforooshzadeh A, Tajali F Urology and Nephrology Research Center, Shaheed Labbafinejad Hospital, Shaheed Beheshti Medical University, Tehran, Iran Introduction and Objective: We evaluated morbidity, survival, general health and functional status of the patients who underwent radical cystectomy (RC) and Life satisfaction was compared in different group of patients. Patients and Methods: All patients who had undergone RC using different bladder reservoir construction techniques between July 2001 and August 2008 in a referral Iranian urologic center were included. Perioperative and postoperative complications in early (less than 3 months) and late phase were recorded from patients’ hospital records. Telephone interviews were made to assess for patients’ survival, life satisfaction, social status, continence and potency. Results: There were 251 patients (mean age: 62.1 (37-82) years; Male/Female: 24/ 227) studied. Bladder reservoir construction technique was orthotopic neobladder in 155, ileal conduit in 57, continent
pouch (appendix diversion) in 16 and ureterosigmoidostomy in 5 patients, also 18 patients had undergone cutaneous ureterostomy. Repeat exploration was necessary in 55 patients and the most common causes were continuous leakage from abdominal drain or suture line and incisional hernia. Ten patients presented with different types of fistula and 7 patients needed a surgery for its management. During a follow up duration of 6 to 91 months, 57 patients had died and follow up information was available for 62 patients. There was no statistically significant difference for life satisfaction between different types of urinary reservoir reconstruction techniques, but patients with ureterosigmoidostomy had lower overall satisfaction. Dependency rate for personal activity was lower in orthotopic neobladder than other urinary reservoirs. Prostate sparing orthotopic ileal pouch had the highest continency and potency rate. Conclusion: This data from a large number of patients with invasive bladder cancer reveal that the patients experience a high complication rate. It seems that life satisfaction is independent of the type of urinary reservoir but patients’ and their families’ acceptance for orthotopic neobladder is higher. MP-13.10 Achieving Pt0n0 at Radical Cystectomy: Outcomes of 135 Pt0n0 Bladder Cancer Patients Treated with Radical Cystectomy: The Canadian Bladder Cancer Network Experience Drachenberg D1, Aprikian A2, Chin J4, Fradet Y3, Izawa J4, Estey E5, Fairey A5, Rendon R8, Cagiannos I6, Lacombe L3, Lattouf J7, Bell D8, Kassouf W2 1 Department of Surgery (Urology), University of Manitoba, Winnipeg, Canada; 2 Department of Surgery (Urology), McGill University, Montreal, Canada; 3 Department of Surgery (Urology), Universite Laval, Quebec, Canada; 4Department of Surgery (Urology), University of Western Ontario, London, Canada; 5Department of Surgery (Urology), University of Alberta, Edmonton, Canada; 6Department of Surgery (Urology), University of Ottawa, Ottawa, Canada; 7 Department of Surgery (Urology), Universite De Montreal, Montreal, Canada; 8 Department of Surgery (Urology), Dalhousie University, Halifax, Canada Introduction and Objectives: Radical cystectomy is the standard treatment for muscle invasive bladder cancer and is increasingly being offered for treatment of T1G3 disease and in a consolidative ap-
UROLOGY 74 (Supplment 4A), October 2009
proach after treatment with neoadjuvant chemotherapy. This has resulted in a significant number of patients with pT0 pathology after cystectomy. We assessed clinical outcomes in patients found to have no evidence of disease, ie pT0N0, in the cystectomy specimen following radical cystectomy for transitional cell carcinoma. Materials and Methods: We collected and pooled a database of 2287 patients who have underwent radical cystectomy between 1993 and 2008 in 8 different centers across Canada. At time of cystectomy, 135 patients were found to have pT0N0 bladder cancer. Variables analyzed included patient age, clinical stage, nodal status, histologic type, previous history of superficial TCC and CIS, use of neoadjuvant chemotherapy, type of pelvic lymph node dissection (none, standard, extended). Survival data were analyzed using Kaplan-Meier method and Cox proportional regression analysis. Results: Median age of patients was 66 years with a mean follow-up time of 42 months. Clinical stage distribution was Tcis 10%, Ta 2%, T1 24%, T2 52%, T3 6%, T4 5%. There were 24% who had a history of concomitant CIS with 35% of patients with a history of previous superficial TCC. Pelvic lymph node dissection was performed in 94% of patients with 65% following standard template and 35% with extended template. There were 8% of patients who received neoadjuvant chemotherapy prior to cystectomy. The 5-year recurrence-free survival, diseasespecific survival, and overall survival was 83%, 96%, and 88% respectively. The 10year recurrence-free survival, disease-specific survival, and overall survival was 66%, 92%, and 70% respectively. There were 83% of patients with TCC as primary pathology. On Cox proportional regression analysis only patient age correlated to overall survival. Conclusions: These results indicate that the finding of pT0 is a predictor of superior outcomes from cystectomy with a high 5 and 10 year recurrence-free survival, diseasespecific survival, and overall survival. It should be noted however that pT0 is not a guarantee of recurrence free survival as there is still a substantial risk of tumor recurrence in this patient population. With increasing utilization of neoadjuvant chemotherapy prior to cystectomy it is likely that increasing pT0 rates will be encountered and the outcomes of this specific group of patients will need to be independently analyzed. As clinical stage was not a prognostic factor, achieving pT0N0 at cystectomy can be used as a surrogate endpoint for survival
S105
MODERATED POSTER SESSIONS
when evaluating efficacy of neoadjuvant chemotherapy.
MP-13.11 Preoperative Hydronephrosis Predicts Poorer Outcomes after Radical Cystectomy for Invasive Bladder Cancer Lee Y, Kim D, Hong S Department of Urology, Yonsei University College of Medicine, Seoul, South Korea Introduction and Objectives: The prognostic significance of preoperative hydronephrosis after radical cystectomy has been investigated in other studies with conflicting results. We investigated whether the presence and severity of preoperative hydronephrosis has prognostic significance in patients who underwent radical cystectomy for invasive bladder cancer. Materials and Methods: Between 1986 and 2005, medical records of 406 patients who underwent radical cystectomy were reviewed retrospectively. According to the Society for Fetal Urology grading system, patients were divided into low (grade 1 and 2) and high grade (grade 3 and 4) hydronephrosis groups. The clinicopathologic factors associated with preoperative hydronephrosis were evaluated and survival was calculated by KaplanMeier method. Results: Of a total of 406 patients, unilateral hydronephrosis was found in 74 (18.2%) patients, bilateral hydronephrosis in 11 (2.7%), and no hydronephoris in 321 (79.1%). Low grade hydronephrosis was found in 57 (12.2%) patients and high grade hydronephrosis in 28 (6%). Preoperative hydronephrosis was related to higher pT stage, LN invasion, positive surgical margin and higher tumor grade. In univariate analysis, patient age, presence of hydronephrosis, hydronephrosis grade, T stage, N stage, tumor grade, surgical margin, number of retrieved nodes, CIS, and lymphovascular invasion were significant prognostic factors after radical cystectomy. In multivariate analysis, age, bilateral hydronephrosis (HR 7.16), high grade hydronephrosis (HR 2.2), pT stage, LN invasion, positive margin and number of retrieved nodes were significant independent risk factors for cancer specific survival. Conclusions: Bilateral hydronephrosis and high grade hydronephrosis predict poor outcomes after radical cystectomy. Preoperative hydronephrosis could be useful for selecting patients and determining
S106
the efficacy of adjuvant chemotherapy stragegies. MP-13.12 Comparison of Hand Assisted Laparoscopic and Open Radical Cystectomy for Bladder Cancer Chen L1, Wang S1, Zhang Y2, Chen W1, Lin H1 1 Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; 2Department of Urology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, China Introduction and Objective: To present our experience of hand-assisted laparoscopic radical cystectomy (HALRC) and compare it with open radical cystectomy ORC). Materials and Methods: During the period of May 2004 and November 2007, 31 patients underwent HALRC and 39 patients underwent ORC for bladder cancer. The patient demographics, intraoperative variables, postoperative outcomes were compared retrospectively. Results: There was no statistically significant difference with regard to age, sex, body mass index, urinary diversion and tumor stage in the two groups. The HALRC group had decreased blood loss(250.9 vs. 812.8cc, P⬍0.001) and lower rate of transfusion (9.7% vs. 76.9%, P⬍0.001), but similar mean operative time (365.7 vs. 362.6minutes, P⫽0.862).Time to liquid diet was significantly less in the HALRC group vs. the ORC group (4.3 vs. 6.3days, P⬍0.001). The median number of lymph nodes were similar between the HALRC and ORC groups (14 vs.15, P⫽0.377). All margins in both groups were negative.Six patients developed perioperative complications in the HALRC group and 12 patients had complications in the ORC group(19.4% vs. 30.8%, P⫽0.278).Late complications occurred in three patients (two parastomal hernias and one ureteroenteral stricture) in the HALRC group. Conclusions: Compared with ORC, HALRC had decreased blood loss, less transfusion requirements and quicker intestinal recovery than ORC. Long term follow-up in a larger cohort of patients is needed to assess long-term oncological and functional outcomes. MP-13.13 Reducing Intraoperative Blood Loss and Transfusion Requirements during Radical Cystectomy: A Comparative Analysis of Three Different Approaches
Chen L, Wang S, Chen Y, Chen J, Chen W, Lin H Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China Introduction and Objective: To compare intraoperative blood loss and transfusion requirements in patients undergoing radical cystectomy using the clamp-and-tie technique,LigaSure versus hand-assisted laparoscopy. Materials and Methods: Eighty-seven bladder cancer patients were enrolled in this study between January 2003 and October 2007. Patients were divided into 3 groups: radical cystectomy using the clamp-and-tie technique (CLAMP group, n⫽32), radical cystectomy using LigaSure (LigaSure group, n⫽24) and hand-assisted laparoscopic radical cystectomy (HALRC group, n⫽31). The serum hematocrits were obtained preoperatively and 24 hours postoperatively in all patients. The intraoperative blood loss volune and transfusion requirements were recorded. Results: The three groups were similar in age, sex, body mass index, previous abdominal surgeries, the number with anaemia, urinary diversion or tumor stage. The LigaSure group had less blood loss (604.2 vs. 835.9ml,p⬍0.05) and lower transfusion rate (66.7% vs 93.8%,p⬍0.05) than the CLAMP group. Compared with the CLAMP group and LigaSure group, the HALRC group had less blood loss and lower transfusion rate(p⬍0.001). However, the mean perioperative change in hematocrit was not significant in the three groups (P⫽0.87),which indicated that the CLAMP group and LigaSure group had more blood loss and higher transfusion volume than the HALRC group intraoperatively. Conclusions: The use of LigaSure is equally as safe and effective at vessel division and hemostasis as the clamp-and-tie technique, with a statistically significant decrease in blood loss and transfusion rate. Hand assisted laparoscopic radical cystectomy results in decreased blood loss and less transfusion requirements than the two open radical cystectomies. The LigaSure has a good effect in hemostasis, and it is also an effective instrument for separation during laparoscopic radical cystectomy.
MP-13.14 Extended Lymphadenectomy While Radical Cystectomy Managadze G, Khvadagiani G, Managadze L National Center of Urology, Tbilisi, Georgia
UROLOGY 74 (Supplment 4A), October 2009