In 2001, Cleveland Clinic's Glickman Urological Institute performed the world's first laparoscopic radical cystoprostatectomy with intracorporeal urinary diversion (ileal conduit or orthotopic neobladder). Since then, over 15 patients have undergone this procedure successfully. Developed by a Clinic urologist, our team first refined this technique in the laboratory and now offers the procedure for patients.
We are able to precisely duplicate all the necessary ablative and reconstructive technical maneuvers laparoscopically, while maintaining established oncologic and reconstructive principles.
The laparoscopic procedure offers several potential advantages over open surgery. In an initial study of our first eight patients, blood loss was only 250 to 450 ml and seven of the eight patients did not require any transfusions. In addition, bowel manipulation was decreased, and there was minimal postoperative pain, resulting in less use of narcotics. Resumption of bowel activity and ambulation occurred early, leading to early discharge. Total operative time has been reduced from 11.5 hours initially to six-and-a-half hours in the more recent cases; the open procedure requires about five hours.
Laparoscopic radical cystoprostatectomy may become an attractive treatment option for selected candidates who have localized muscle-invasive bladder cancer. The procedure is currently restricted to patients with a small-volume bladder cancer without extravesical involvement or pelvic lymphadenopathy on abdominal computed tomography. We are able to construct a neobladder (new bladder) using a segment of small bowel, employing pure laparoscopic techniques exclusively.
Why would someone need a laparoscopic radical cystoprostatectomy?
Laparoscopic radical cystoprostatectomy might be an option for patients who experience recurrent high-grade superficial bladder cancers or invasive bladder cancers. However, if a patient's cancer has metastasized (spread to other parts of the body), this procedure may not be recommended. Your Cleveland Clinic doctor will take into consideration a variety of factors before recommending a laparoscopic radical cystoprostatectomy.
What happens before laparoscopic radical cystoprostatectomy?
Prior to surgery, your doctors will test to ensure that the cancer has not spread beyond the bladder and prostate. Additional testing will be done to see if you are at risk for comorbidities such as heart and lung disease.
A preoperative evaluation is typically recommended by Cleveland Clinic physicians to help plan for the challenge of managing a urinary stoma postoperatively and the need for stomal site marking prior to surgery.
You will be asked to not eat anything after midnight the day before surgery. If your doctor asks you to take medications, you'll take them with small sips of water. Additionally, you'll be asked to undergo a bowl preparation to help clear out your digestive system (this helps give the surgeon more room to work and cuts down on risks).
Before the surgery, you'll be given general anesthetic with muscle relaxation. A laparoscopic radical cystoprostatectomy typically lasts between 3 to 5 hours.
What happens during laparoscopic radical cystoprostatectomy?
During laparoscopic radical cystoprostatectomy, your surgeon will remove your bladder and prostate by creating several small incisions (this is less traumatic than an open surgery and will help you to heal better). After being removed, your surgeon will have several options to create a new bladder (neobladder) from existing tissue. It is important that you ask your doctor about the specifics of the surgery as all patients are different.
What happens after laparoscopic radical cystoprostatectomy?
After the procedure, you’ll be guided into a recovery room where nurses will monitor your condition until you are awake and stable. You’ll be given medication for pain as needed (some patients will have an epidural, others will receive narcotics as needed, depending on the patient).
Our expert staff will provide you with Intravenous (IV) fluids to provide you nutrition until your digestive track recovers enough to take solid food. If you eat or drink too soon after surgery, you can experience nausea, vomiting, or other side effects. Our nurses will encourage you to sit up and to walk around as soon as possible after surgery. Doing so has several benefits. It encourages blood flow (which helps healing and prevents blood clots) and promotes oxygen flow (to prevent pneumonia and help healing).
After you are cleared to go home you’ll be prescribed medication to manage pain, treat potential constipation, and to prevent infections (antibiotics).