Robotic Cystectomy

What is cystectomy?

A cystectomy is a major surgery to remove the entire bladder (radical cystectomy) or part of the bladder (partial cystectomy). It is usually done to treat bladder cancer.

In an open radical cystectomy, surgeons remove the entire bladder through a long incision (cut) in the abdomen (belly area). The bladder is removed along with surrounding lymph nodes. The surgeon then reconstructs the urinary tract so urine can move out of the body.

Depending on how the cancer has advanced, it is necessary to remove parts of the reproductive system (including the prostate, seminal vesicles in men; cervix, ovaries, fallopian tubes, uterus, part of the vaginal wall in women).

What is robotic cystectomy?

A robotic radical cystectomy does the same thing, but is less invasive, using smaller incisions in the abdomen. A robotic console (pictured ) helps the surgeon guide instruments more precisely in the body.

A robotic partial cystectomy is done where the cancer has invaded only part of the bladder. Most times, however, a radical cystectomy is needed to treat bladder cancer. Your doctor will explain to you what type of surgery will be necessary.

Recent studies suggest cancer control results of robotic cystectomy compare well with traditional open surgery.

How is robotic cystectomy performed?

You will be under general anesthesia (asleep) during this operation.

• Your abdomen is inflated with carbon dioxide to create working space for your surgeon.
• Very small incisions are made in the abdomen so that long instruments, including a high-magnification camera, can be inserted into the body cavity. You should understand that the robot is not doing the surgery. The surgeon controls the robotic instruments through a surgical console.
• The surgeon uses the robotic instruments to remove the bladder, lymph nodes and surrounding organs.
• The surgical robot enhances the operation by providing three-dimensional, high-definition vision and improved instrumental dexterity. The robotic arms holding the instruments are completely controlled by the surgeon at the console, using precise movements to perform the operation.
• If your surgeon prefers to perform the urinary tract reconstruction in a traditional open fashion, then you will have a small incision around your belly button that facilitates this part of the procedure. If your surgeon prefers to perform the urinary tract reconstruction using the robot, then the surgeon’s and assistant’s hands never enter the body cavity.

When a radical cystectomy is performed, your surgeon needs to reconstruct the urinary tract in one of three ways so that your urine can be eliminated from your body. These methods include:

• Ileal conduit: Your surgeon disconnects a short portion of your small intestine called the ileum. The ureters (tubes that carry urine from the kidney to the bladder) are attached to one end of the ileum, while the other end of the ileum is attached to an opening in the skin called a stoma. The stoma is usually located close to the belly button on the right side. A plastic appliance (ostomy bag) is placed over the stoma to collect urine.
• Continent cutaneous diversion: Your surgeon creates a continent reservoir to store urine from part of your small and large intestine. The ureters are attached to one end of the reservoir, and the other end of the reservoir is connected to a small opening (stoma) in the skin of your abdomen. The reservoir stores urine and must be emptied periodically by inserting a small drainage tube (catheter) into the stoma. No external bag is necessary.
• Neobladder: Your surgeon uses a long piece of small intestine to create a continent reservoir to store urine. The ureters are attached to one end of the reservoir, and the other end of the reservoir is connected to the urethra, the tube that carries urine out of your body, so you can pass urine in a similar way to what you did before surgery. You empty your reservoir periodically by relaxing your pelvic muscles and tensing your abdominal (belly) muscles.

What are the benefits of robotic cystectomy?

• Robotic cystectomy provider the surgeon with better visualization of the surgical site.
• Compared with laparoscopy, the robot’s wrists allow for an increased range of motion, which allows the surgery to be performed in a more precise manner.
• Robotic cystectomy also has the usual benefits of less invasive surgery:
• Shorter hospital and recovery time (ask your doctor about your specific situation)
• Less blood loss
• Less pain and decreased need for narcotic pain medication
• Minimal scarring of the surgery site

What are the risks of robotic cystectomy?

Cystectomy is major surgery and any major surgical procedure has risks. Generally, these will include:

• Bleeding
• Blood clots
• Infection
• Organ damage
• Reactions to anesthesia

You may also have changes in how you urinate after any bladder surgery. Your bladder is smaller after partial cystectomy, so you may need to go to the bathroom more often. If you have a radical cystectomy, your ability to urinate depends on the type of reconstructive surgery you have.

For some men, bladder removal surgery causes sexual side effects. Men may have difficulty getting and maintaining erections. Because doctors remove the seminal vesicles and prostate along with the bladder during a radical cystectomy, men will no longer produce semen.

Women may also experience sexual side effects. While intercourse is still possible, it may cause discomfort if doctors remove part of the vagina. The nerves that are responsible for arousal and orgasm are sometimes affected during radical cystectomy.

What is the recovery period for people who have cystectomy?

Your recovery depends on the type of bladder removal surgery you have. Typically, patients who undergo a partial cystectomy will have a shorter recovery period compared with patients who undergo a radical cystectomy.

Many patients will have poor appetite and abnormal bowel function (constipation, loose stools or both) immediately after radical cystectomy, and complete recovery may take several weeks to months. This is a direct result of using a part of your bowel for the urinary diversion.

After robotic cystectomy, contact your doctor immediately if you experience:

• Signs of infection such as fever and shaking chills
• Nausea and vomiting that will not stop
• Heavy bleeding and increase in redness, pain, swelling or discharge from the surgical area
• Pain you are unable to control with medications you are given
• Difficulty urinating or with draining urine from your urinary reconstruction