About Robotic Cystectomy (Robotic-Assisted Radical Cystectomy)
The standard of care for patients with muscle invasive bladder cancer or aggressive bladder cancer is a radical cystectomy—surgical removal of the entire bladder plus the regional lymph nodes.
Traditional open surgery consisted of an incision stretching from the belly button to the pubic bone. Robotic radical cystectomy is now emerging as a viable alternative for bladder cancer patients, which allows for a series of much small incisions. The enhanced visualization and control of the da Vinci Si surgical robot affords the surgeon a level of precision comparable, or even superior, to that of open surgery. The other benefits of robotic surgery include less intra-operative blood loss, quick recovery and less pain.
Some patients with muscle invasive bladder cancer are good candidates for chemotherapy before surgery to help control the cancer with several treatment steps. Robotic surgery can also help patients who have had prior chemotherapy recover more quickly. Our surgeons at Stony Brook Medicine work as part of a multi-disciplinary team with medical oncologists and radiation therapists at our Cancer Center.
Lymph Nodes
In addition to removing the bladder, a pelvic lymph node dissection is also performed as part of the procedure. Robotically, we are able to visualize the lympatic tissue well. Using the 3-D High Definition vision, we can remove a higher number of lymph nodes, which improves staging of the cancer and may improve cancer survival. Robotics allows for high accuracy during the delicate dissection of the lymph nodes from important nerves and blood vessels with minimal blood loss.
Urinary Reconstruction
Following removal of the bladder, patients will need to undergo urinary reconstruction as part of the procedure. This requires the surgeon to use tissue from the patient’s intestine to create a new way for the body to expel urine. Our surgeons are highly skilled and can offer several different options for urinary reconstruction including:
- Ileal conduit (urostomy): In this approach, the surgeon uses part of the patient’s intestine to create a channel (or conduit) that connects the ureters (the tubes that drain the kidneys) to a stoma – which is an opening in the abdominal wall where a bag collects the urine. This bag is then emptied 3 or 4 times a day.
- Creation of an orthotopic neobladder (new bladder): In properly selected patients, a new bladder may be fashioned from intestine to allow the patient to pass urine out of the body through the urethra. This most closely resembles the way patients passed urine prior to surgery. This method avoids the need for an external appliance.
- Creation of a continent catheterizable reservoir. In patients who aren’t candidates for a neobladder but still desire a life without the need for an external appliance, this approach may work well. In this procedure the intestinal tissue is used to create an internal pouch for the urine. The patient passes a small catheter into the pouch 3-4 times per day to drain the urine. The opening for passage of the catheter is typically not easily visible as it is hidden in the belly button.
Advantages of Robotic Radical Cystectomy
1) Decreased blood loss than open surgery. This reduces the need for blood transfusions.
2) Optimal surgical visualization with a 3-D High Definition View
3) Decreased pain and minimal scarring of the skin surface. Allowing quicker recovery time, and perhaps, an improvement in returning to function and quality of life.
4) Improved lymph node dissection. When more lymph nodes are removed, more information about cancer staging is available to help identify patients that may need additional cancer therapy. In addition, this may increase the cure rate.