What Is Robotic Assisted Cystectomy?

A cystectomy is a surgical procedure for removing the urinary bladder. A major form of surgery, it is most commonly performed as a treatment for cancer. There are two types of cystectomies: partial and radical. In a partial cystectomy, only a portion of the bladder is removed. The entire bladder is removed in a radical cystectomy. In the most serious cases, when the cancer has spread, some of the reproductive organs – the cervix, ovaries, and uterus in women and the prostate and seminal vesicles in men – are excised as well. A patient’s urinary tract is surgically reconstructed following a total bladder removal.

A robotic assisted cystectomy is a minimally invasive alternative to open, large-incision surgery. It has several advantages over the traditional method, including decreased blood loss, less post-operative discomfort, and shorter recovery times.

Baptist Health is a regional leader in using advanced surgical technology for urological conditions. Robot-assisted cystectomy is performed at several of our facilities in Kentucky and Indiana.

Benefits of Robotic Assisted Cystectomy Over Traditional Surgery

A robotic procedure does not mean being operated on by a mechanical man rather than a human being. Robotic procedures are robot-assisted procedures, where the robot is a group of tools used by a surgeon and his or her medical team to aid in an operation. These tools are called robots because they mimic human motions and movements, sometimes with greater precision and less fatigue than we’re capable of.

Robotic surgery offers the following benefits:

• Smaller incisions than with open surgery, and therefore less blood loss
• Reduced scarring
• Lower risk of infection
• Decreased post-surgical pain
• Shorter hospital stays
• Quicker recovery times
• Faster return to normal living

Although robotic surgery is beneficial for many patients, it is not without risks. Any surgery, open, endoscopic, laparoscopic, or robotic, carries with it the possibility of infection, internal bleeding, organ damage, and adverse reactions to anesthesia. In numerous cases, however, these risks are lower with robot-assisted surgery.

Treatment

At Baptist Health, robot-assisted cystectomies are performed with the aid of the Intuitive da Vinci system. Intuitive is a leading American manufacturer of medical robots and related equipment.

The Intuitive da Vinci system has three parts:

• A multi-armed robot for making incisions and inserting cameras and other surgical instruments in the patient.
• A vision cart with endoscopic monitors that provide the surgeon with magnified, three-dimensional, real-time images of the surgical site within the body.
• A computerized panel from which the surgeon controls the robot and performs the procedure.

A robotic cystectomy is conducted similarly to laparoscopic and other forms of minimally invasive surgery. The robot makes tiny incisions for the insertion of a camera – the surgeon’s eyes during the procedure – and other operating instruments for removing the bladder, the adjacent lymph nodes, and any other cancerous organs. However, a robot-assisted procedure has the advantage of greater precision than a human operating alone because robot technology downscales the surgeon’s hand motions to extremely fine movements, reducing the possibility of organ or tissue damage.

Procedure

Your medical team will provide instructions on preparing for surgery. You can expect to fast for a period of time prior to the procedure. Your physician will also advise you on taking your regular medications beforehand. Arrange to have someone drive you home from the hospital, after your release.

A robot-assisted cystectomy involves several steps. Your surgical team will:

• Administer a general anesthetic, so that you sleep through the procedure.
• Place you in a supine position – on your back – on the surgical table.
• Pump carbon dioxide gas into your abdomen to open up an operating space.
• Make five or six small incisions in your abdomen through which the camera and other surgical tools will be inserted.
• Cut away and extract the bladder, lymph nodes, and other tissues or organs with evidence of cancer.
• Close the incisions if only part of the bladder was removed.
• Reconstruct the urinary tract if the entire bladder was removed, and finish by closing the incisions.

There are three primary methods of enabling a patient without a bladder to pass urine from the body. Two of these, ileal conduit and continent cutaneous diversion, create spaces for urine collection that is voided through an artificial opening called a stoma. Collection occurs externally in the first case by means of a plastic device called an ostomy bag. Collection occurs internally in the second case, with urine being removed by a catheter. In the third method, your surgeon fashions a neobladder from the small intestines, which is connected to your urethra and functions as a substitute disposal organ.

Recovery Process

Cystectomies are major surgery requiring a certain degree of recovery time (though less with minimally invasive procedures, such as robot assisted surgery). During your recovery period:

• Increase physical activity gradually. Avoid heavy lifting or strenuous movement. Walking is a good first exercise.
• Limit bending over, which is stressful to the abdominal region.
• Don’t plan on driving until consulting with your physician.
• Wash and dry your incisions. Shower rather than bathe.
• Drink water and other fluids to improve the flow of urine.
• Eat normally, starting with small portions.
• Keep follow-up appointments with your provider.

What Is the Recovery Time for Robotic Assisted Cystectomy?

Recovery periods for cystectomies vary by patient and depend on whether part or all of the bladder is removed. Patients with minimally invasive procedures, including robot assisted surgery, recover more quickly than those with traditional open procedures. Some patients are able to take up their daily routine in as little as three weeks. The full recovery period for many persons ranges from six to eight weeks.

How Long Does It Take for Robotic Laparoscopic Incisions to Heal?

In most cases, it takes a week or two for the skin to close and scabs to form following a laparoscopic procedure. Incisions heal more fully in six to eight weeks, with small scars remaining in place of scabs.

Potential Risks and Complications

Like any surgery, a robot assisted cystectomy carries a risk of complications. The most common medical issues include:

• Urinary tract problems: Obstructions sometimes form in the ureters, the tubes that transport urine out of the kidney.
• Gastrointestinal concerns: In a radical procedure, the surgeon may incorporate the small intestines to some extent into the reconstructed urinary tract. This can lead to a loss of efficiency in the small intestines, resulting in constipation and other issues.
• Nerve injury: Pelvic nerves are at risk in any surgical procedure involving the bladder or the neighboring lymph glands. This risk is lower with a robotic procedure, because of the extreme precision of robot-controlled movements.
• Incision infections: Infections can develop at the incision sites or at a surgically created stoma.

Long-term Outlook and Quality of Life

Medical data support the use of robot assisted cystectomies as a method of treating cancer. Persons undergoing this procedure have survival rates above those who have not had the surgery. However, you should be aware that bladder-removal surgery can impact your quality of life. Individuals with a radical cystectomy will find that it takes time for a reconstructed bladder to function as effectively as the one that was removed. Cystectomies can also affect sexual activity in both men and women.

Finding a Specialist

A robotic assisted cystectomy is an effective procedure for treating bladder cancer. As a minimally invasive form of surgery, robot-assisted procedures have several advantages over traditional open surgery. Baptist Health is committed to being a leading medical provider of robot-assisted diagnosis and surgery in Kentucky and Southern Indiana. If you have questions or concerns about your kidney, bladder, or urological health, contact one of our specialists.

Call to schedule a consultation today!