What is a robotic partial cystectomy?

Robotic 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.

What outcomes are expected from a robotic partial cystectomy?

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.

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.

Why would someone need a robotic partial cystectomy?

Robotic partial cystectomy is typically done on very select few cases of bladder cancer. There is a screening process your doctor will determine if you're a candidate. In order to be considered for this particular procedure, you'll be screened for multifocal bladder cancer or evidence of metastatic cancer, both of which must be negative. Further, your doctor will have to decide if your bladder will be large enough post operation to be functional.

However, if you meet this criteria, robotic partial cysectomy is an option available at Cleveland Clinic.

What happens before a robotic partial cystectomy?

As with all surgeries, you’ll be asked to stop taking aspirin, NSAIDS (including Advil, Ibuprofen, and Aleve) or other blood thinning medications at least a week prior to surgery. Because certain herbal medications or supplements also increase risk of bleeding during surgery, your doctor will advise you which supplements to cease using before surgery. Ask your doctor about using other medications such as antibiotics or blood pressure medication prior to surgery. Do not discontinue any medication without being advised by your doctor to do so.

Other medications such as Warfarin or Plavix also may need to be ceased at least 5 days before surgery to decrease bleeding risk.

Your doctor will also ask you to stop smoking. Besides the negative health consequences that smoking has, smoking can lead to higher risks both during and after surgery. Tobacco has been proven to slow down the healing process and decrease the effectiveness of the immune system.

Your diet will have to change the day prior to surgery most doctors recommend that you should follow a clear liquid diet starting the morning before your surgery.This includes juices without pulp, soup broth, and Jell-O.

It is also important to arrange for someone to care for you after surgery as returning to normal activity is not recommended immediately after surgery.

What happens during a robotic partial cystectomy?

During a robotic partial cysectomy, your surgeon will use a state of the art surgical robot to remove part of your bladder. Using the robot allows your Cleveland Clinic surgeon very precise and accurate movements as well as a much better view of the surgical area. The camera allows your doctor to see much more clearly than in a traditional open surgery.

What happens after a robotic partial cystectomy?

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).

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