COMBINED LAPAROSCOPIC AND TRANSURETHRAL NEODYMIUM - YTTRIUM-ALUMINUM-GARNET LASER TREATMENT OF INVASIVE BLADDER-CANCER

Objectives. The feasibility and efficacy of combined cystoscopic and l aparoscopic neodymium: yttrium-alwminum-garnet (Nd:YAG) laser coagulat ion of invasive bladder cancer were investigated. Methods. Five patien ts with extensive Stage T2-T3a bladder cancer who were not candidates for radical cystectomy were treated by Nd:YAG laser irradiation. All p atients also underwent transperitoneal laparoscopic mobilization of th e intestine away from the bladder with continuous monitoring of the la ser treatment. In 2 cases, laser therapy of the serosal surface of the bladder at the site of tumor was also administered. Results. The proc edure was completed without complications in all 5 patients. A mean of 58,607 joules (J) of energy was delivered transurethrally with an add itional 8000 to 10,000 J utilized via laparoscopy in 2 cases. Local di sease recurrence was noted within 1 to 4 months in 4 of the 5 patients . Distant metastases were detected within 1 to 9 months postoperativel y in 3 of 5 patients. No perioperative bowel or bladder perforation oc curred. Conclusions. The use of laparoscopy allows for the safe delive ry of large amounts of laser energy to the bladder. However, in this s mall group of patient's with extensive bladder tumors, effective palli ation of local disease could not be reliably achieved. Further study i s necessary to determine whether treatment modifications or selection of patients with less extensive tumors will lead to better results wit h combined laparoscopic and cystoscopic laser therapy.