Transcript Dia 1 - Urologenarnhem.nl

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Introduction of new techniques:
First experiences in robot assisted laparoscopic
brachytherapy catheter implantation in muscle invasive
transitional cellcarcinoma of the bladder
Results
Introduction & Objectives
The laparoscopic placement of the brachytherapy-catheters appeared feasible, uneventful and without perforation of
the mucosa and resulted in a perfect geometry and anatomic position. The Tilepro application of was of great benefit
for the console surgeon during RAL-BI. The operating time decreased from 258 minutes in the first (laparoscopic)
case to 70 minutes in the last (robot assisted) cases (150 min mean-time in O-BI). Blood loss was nihil and there
were no per-and post-operative complications. Average hospitalization was 6 days (5-12 days), in the O-LI group this
was 10 days (7-25 days). The irradiation consisted of pre-operative external radiotherapy (three fractions of 3.5 Gy or
20 fractions of 2 Gy for T1 or T2 tumors, respectively) and the brachytherapy (equivalent to 60 or 30 Gy). Position of
the catheters appeared to be superior in the laparoscopy group as depicted by imaging techniques and , in contrast
to the O-BI, no interruptions caused by radiation source jamming occurred. There was no early toxicity in the
laparoscopy group.
Using strict criteria, solitary muscle
invasive TCC of the bladder can be
managed favorably in a bladder sparing
manner with brachytherapy. Hollow
catheters
used
for
after-loading
radiotherapy are placed in the bladder
wall. Until now, this is performed by open
surgery worldwide. In order to reduce the
morbidity and toxicity of this procedure,
our goal was to replace the open surgery
(O-BI) by laparoscopy (L-BI) and
eventually robot laparoscopy (RAL-BI).
We report the first experiences and
clinical outcome.
Conclusions
By using specially developed needles, the application of brachytherapy catheters by laparoscopy appears feasible
in solitary muscle invasive TCC of the bladder and results in superior per en postoperative outcomes. In addition,
an improved accuracy in after loading is established. We are aware of the still limited experience and follow-up,
however, these favorable results prompt us to continue the laparoscopic approach using the da Vinci Si® platform.
Material & Methods
Ten patients with solitary muscle
invasive T2 TCC of the bladder (N = 8)
or TCC of the distal ureter (N = 2) were
treated between June 2009 and
October 2010. Laparoscopy and
cystoscopy
were
performed
simultaneously in order to identify the
exact location of the tumor area. Using
specially
developed
needles
(Nucletron), 3 to 4 brachytherapy
catheters were inserted by laparoscopy
in the 'clinical target volume' under
cystoscopic control. The last 2
procedures were performed with the da
Vinci Si® robot, using the Tilepro
application (RAL-BI). Results and
outcome are compared with the earlier
series OBI in our institute (n=96, 19962009).
Smits,
1
G.A.H.J. ,
Wijburg,
1
C.J. ,
Kums,
1
A.C.M. ,
Campschroer,
1
T. ,
Van Der Steen-Banasik,
2
E.
1) Rijnstate Hospital, Dept. of Urology, Arnhem, 2) Arnhem Radiotherapeutic Institution, ARTI, Arnhem, The Netherlands