Robotic Cystectomy Surgery for Bladder Cancer

Robotic cystectomy surgery for bladder cancer at a glance:

  • Robotic surgery for bladder cancer is known as a robotic cystectomy and is a minimally invasive way to surgically treat bladder cancer by removing the entire bladder or a portion of it affected by cancer.
  • The traditional way to perform surgery for bladder cancer involves an open incision across the abdomen.
  • Pacific Urology uses the da Vinci brand of robotic surgery device to perform robotic cystectomy.
  • During a robotic cystectomy, the surgeon controls the robotic device while the patient lies on a surgery table.
  • Benefits of robotic cystectomy include a better view of the bladder and a more delicate way to remove the bladder, as well as faster recovery times and less blood loss. 

What is robotic cystectomy surgery for bladder cancer?

Bladder cancer begins in the tissue of the bladder. When the cancer is invasive and far along, surgery will be the primary treatment option for the patient. Traditionally, bladder cancer surgery was treated with a surgical procedure known as a radical cystectomy, which included an open incision throughout the abdomen.

With the advent of robotic surgery, physicians now have an alternative way to treat bladder cancer with a more delicate and less invasive manner that can provide less post-operative complications. Robotic surgery for bladder cancer is known as a robotic cystectomy. Pacific Urology uses the da Vinci brand of robotic surgery device when performing a robotic cystectomy.

How is robotic surgery for bladder cancer performed?

During any robotic surgery procedure, the patient rests on a table and the surgeon sits at a control panel where he or she operates the robotic device that is positioned above the patient. During a robotic cystectomy, the surgeon makes a series of small incisions across the abdomen to access the bladder and surrounding areas. Depending on how much the cancer has spread, the surgeon may also remove surrounding tissue and organs such as the prostate, ovaries or uterus.

If the entire bladder is removed during surgery, a urinary diversion systems and reconstruction will be required so that the patient can drain urine from the kidneys following the surgery. Types of diversion methods include an ileal conduit (made from the patient’s intestine connected to the skin, and the patient wears an external bag to hold urine), orthotopic neobladder (new internalized bladder made from the patient’s intestine and connected to the patient’s own urethra), or a continent cutaneous urinary diversion (completely internal pouch that collects urine, which must be intermittently drained by the patient with a catheter).

Benefits of robotic cystectomy for bladder cancer

The primary benefit of robotic surgeries is the surgeon’s ability to view the area with higher magnification that better distinguishes tissues. This may result in the preservation of more healthy tissue while removing cancerous tissue. The abdomen is inflated with air during surgery, which compresses small blood vessels. Because of this, the surgeries can result in less blood loss. Incisions are smaller than with traditional surgery, which may mean less recovery time and overall blood loss. Less pain and less use of pain medications may lead to quicker return of bowel function and return to a regular diet.

Robotic surgery can be a better option for patients compared with open surgery or minimally invasive laparoscopy procedures. Benefits include:

  • Less scarring
  • Less blood loss
  • Preservation of the bladder’s healthy tissue
  • Better access to the bladder
  • Decrease in pain, risk of infection or complications (less infection and complications are debatable).

Risks and considerations of robotic cystectomy for bladder cancer

All surgery comes with inherent risks such as adverse reaction to anesthesia, blood loss and infection. Specific risks for robotic-assisted surgeries may include:

  • Inability to complete surgery due to patient anatomy or extent of the cancer, requiring conversion to traditional surgery method
  • Longer surgery time
  • Longer anesthesia time
  • Nerve damage from positioning during surgery
  • Loss of tactile feedback for the surgeon (ability to feel tissues during surgery)
  • Injury to patient because of improper device positioning.

A patient reduces the above risks by selecting a surgeon with a high mastery of the da Vinci system. Even though a robotic cystectomy is minimally invasive, there is still a lot of recovery time required. Not all patients may be candidates for robotic surgery based on the extent of their cancer, body anatomy and comorbid conditions. Most of the time, patients undergoing a robotic cystectomy return to all normal activities within 6 to 8 weeks following their surgery.

For more information on robotic surgery risks and considerations read the Robotic Surgery overview page.