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Derivação urinária intracorpórea após cistectomia radical robótica
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Introdução: A cistectomia radical com linfadenectomia pélvica constitui o gold-standard para o tratamento do carcinoma vesical invasivo e dos tumores recorrentes de alto grau. Este procedimento é mais frequentemente realizado por via aberta, porém, tem havido uma tendência crescente para a realização de cistectomias radicais laparoscópicas assistidas por robot (CRLAR). A construção de uma derivação urinária intracorpórea (DUIC) apresenta vários potenciais benefícios, mas atualmente apenas existe um número limitado de estudos que comparam a DUIC com a derivação urinária extracorpórea (DUEC) na cirurgia minimamente invasiva.
Objetivos: Descrever as técnicas de derivação urinária intracorpórea e comparar bibliografia mais recente relativa aos outcomes perioperatórios da DUIC e da DUEC.
Materiais e Métodos: Foi feita uma revisão da literatura restrita a artigos em inglês, de 2003 a 2023, com recurso a pesquisa de palavras-chave em bancos de dados eletrónicos (PubMed, Science Direct e Google Scholar).
Resultados: Foram avaliados 12 estudos com um total de 3056 doentes submetidos a uma derivação urinária (57,1% DUIC e 42,9% DUEC) havendo um predomínio na construção de condutos ileais numa proporção de 1,5:1 relativamente à construção de neobexigas. Os doentes do grupo da DUIC parecem ter tempos operatórios superiores, mas menores perdas de sangue, estadias hospitalares, taxas de transfusões e taxas de complicações pós-operatórias comparativamente aos doentes do grupo da DUEC.
Conclusão: A realização da DUIC após a CRLAR tem aumentado exponencialmente e constitui um procedimento viável e seguro quando realizado por uma equipa cirúrgica experiente. Apesar de ser uma técnica complexa e de alto risco, parece apresentar algumas vantagens relativamente à abordagem extracorpórea.
Introduction: Radical cystectomy with pelvic lymphadenectomy is the gold standard for the treatment of invasive bladder cancer and recurrent high-grade tumors. This procedure is most often performed by laparotomy, however, there has been a growing trend towards performing robot-assisted laparoscopic radical cystectomies (RALRC). An intracorporeal urinary diversion (ICUD) has several potential benefits, but currently there are only a limited number of studies comparing the ICUD with the extracorporeal urinary diversion (ECUD) in minimally invasive surgery. Objectives: To describe the intracorporeal urinary diversion techniques as well as to compare the most recent literature on the perioperative outcomes of DUIC and DUEC. Materials and Methods: A literature review restricted to articles in English, from 2003 to 2023, was carried out using keyword research in electronic databases (PubMed, Science Direct and Google Scholar). Results: We evaluated 12 studies with a total of 3056 patients undergoing urinary diversion (57,1% ICUD and 42,9% ECUD) with a predominance in the construction of ileal conduits with a predominance in the construction of ileal conduits in a ratio of 1.5:1 in relation to the construction of neobladders. Patients in the ICUD group appear to have longer operative times, but lower blood loss, hospital stays, transfusion rates and postoperative complication rates compared to patients in the ECUD group. Conclusion: The performance of ICUD after RALRC has increased exponentially and is a viable and safe procedure when performed by an experienced surgical team. Despite being a complex and high-risk technique, it seems to have some advantages over the extracorporeal approach.
Introduction: Radical cystectomy with pelvic lymphadenectomy is the gold standard for the treatment of invasive bladder cancer and recurrent high-grade tumors. This procedure is most often performed by laparotomy, however, there has been a growing trend towards performing robot-assisted laparoscopic radical cystectomies (RALRC). An intracorporeal urinary diversion (ICUD) has several potential benefits, but currently there are only a limited number of studies comparing the ICUD with the extracorporeal urinary diversion (ECUD) in minimally invasive surgery. Objectives: To describe the intracorporeal urinary diversion techniques as well as to compare the most recent literature on the perioperative outcomes of DUIC and DUEC. Materials and Methods: A literature review restricted to articles in English, from 2003 to 2023, was carried out using keyword research in electronic databases (PubMed, Science Direct and Google Scholar). Results: We evaluated 12 studies with a total of 3056 patients undergoing urinary diversion (57,1% ICUD and 42,9% ECUD) with a predominance in the construction of ileal conduits with a predominance in the construction of ileal conduits in a ratio of 1.5:1 in relation to the construction of neobladders. Patients in the ICUD group appear to have longer operative times, but lower blood loss, hospital stays, transfusion rates and postoperative complication rates compared to patients in the ECUD group. Conclusion: The performance of ICUD after RALRC has increased exponentially and is a viable and safe procedure when performed by an experienced surgical team. Despite being a complex and high-risk technique, it seems to have some advantages over the extracorporeal approach.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Cistectomia radical robótica Derivação urinária intracorpórea Derivação urinária extracorpórea Resultados perioperatórios Urologia