Glickman Urological & Kidney Institute

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Robotic Partial Cystectomy

Cleveland Clinic offers minimally invasive treatment options for patients with localized muscle-invasive bladder cancer. The robotic laparoscopic bladder surgery procedure offers advantages over open radical cystectomy (removal of the bladder using a relatively large abdominal incision) in that there is a quicker recovery time.

Cleveland Clinic urologists performed the world's first laparoscopic removal of a cancerous bladder, followed by surgery to reconstruct the bladder out of intestinal tissue. Developed by a Cleveland Clinic urologist, our team first refined this technique in the laboratory and now offers the reconstructive bladder cancer surgery for patients.

In addition to treating bladder cancer, robotic laparoscopic bladder surgery can also be used to treat urinary incontinence.

Description

Partial cystectomy is indicated in specific cases of solitary dome/anterior wall bladder TCC, such as small unifocal tumors, solitary tumors in a bladder diverticulum, no concomitant carcinoma in situ (cis) or localized urachal adenocarcinoma. The goal of this surgical approach is to maintain a functional reservoir, while preserving continence and erectile function in male patients.

In the case of these very specific tumors, the laparoscopic approach has the following advantages: a shorter recovery time and reduced length of hospital stay as compared with the open surgery approach.

Outcomes

These surgical outcomes are available for download.

Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation.

All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation.

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