A single-institutional analysis of laparoscopic 3D radical cystectomy with intracorporeal urinary diversion.

Abstract

Introduction: In centers with limited access to robotic platforms, the laparoscopic approach represents a feasible alternative for complex urological procedures such as radical cystectomy with intracorporeal urinary diversion. Although technically demanding, outcomes may become comparable to those reported for robotic surgery once the learning curve is overcome. This study aims to evaluate this hypothesis.

Methods: We included patients who underwent laparoscopic radical cystectomy (LRC) between 2017 and 2025 at the Urology Department of the Municipal Clinical Hospital Cluj-Napoca. The optimal urinary diversion was chosen based on patient characteristics. Perioperative, postoperative, and oncological outcomes were evaluated as well as the impact of learning curve on these characteristics.

Results: We identified 124 patients who underwent LRC. Median estimated blood loss (EBL) was 300 mL (IQR 200-450 mL), and perioperative transfusions were required in 26 cases. A standard pelvic lymphadenectomy yielded a median of 14 lymph nodes (IQR 10-17). Major complications were encountered in 15% of cases. At 12 months follow-up, uretero-ileal strictures were identified in 8 patients with intracorporeal urinary diversion. Total operative time, EBL and the rate of major complications were significantly influenced by surgeon experience.

Conclusion: The laparoscopic approach, even in complex procedures such as radical cystectomy with intracorporeal urinary diversion, respects the principles of minimally invasive surgery and represents an alternative for centers with limited access to robotic platforms.