Laparoscopic repair of iatrogenic bladder perforation during transurethral bladder tumor resection: Case report and literature review
A 82-year-old woman presented with gross hematuria. Cystoscopy showed a 25-mm bladder tumor at the posterior bladder wall. She underwent TURBT, which revealed T1 high grade urothelial carcinoma. She underwent staging TURBT after 4 weeks which again showed T1 high grade urothelial carcinoma. She denied radical cystectomy and therefore TURBT was repeated after another 4-week interval. Deep tumor resection was performed using a flat, equatorial loop to resect the posterior wall tangentially. During the resection which took 20 minutes, there was an inadvertent intraperitoneal perforation of the bladder. This was recognized by cystoscopic visualization of the intraperitoneal cavity through a laceration in the middle of the resected area near the dome, while fulgurating the edges at the completion of the procedure. Immediately, exploratory laparoscopy was performed by a colleague from the department of general surgery experienced in laparoscopic techniques showing a 20-mm rupture at the posterior wall of the bladder. Three trocars were used, a 10 mm umbilical trocar and two 5 mm trocars, one in each iliac fossa. There was no injury to the bowel and the bladder was repaired with two absorbable 2-0 vicryl sutures using a one-layer full-thickness suture pattern. Successful repair was confirmed by saline instillation through the cystoscope. While TURBT took 20 minutes, the laparoscopic repair took another 30 minutes. Both procedures were done under general anesthesia. A percutaneous intraperitoneal 12F silicon drain was placed to monitor for possible urine extravasation post operation. For bladder drainage, a transurethral Foley catheter was used. Five days after the operation a cystogram revealed no evidence of leak, and the catheter was removed. The patient was discharged on the seventh postoperative day and further recovery was uneventful.