Advances in the medical field allow for bladder removal performed robotically with minimal risks.
Twenty-five percent of the 70,000 Americans diagnosed with bladder cancer each year eventually need to have their bladder removed in an attempt to successfully treat the disease. One such procedure that may be performed is a radical cystectomy, which is removal of the entire bladder and some nearby structures. A newer variation on this type of surgery is a robot-assisted radical cystectomy.
For women, this might include the uterus and ovaries and part of the vagina.
Men having this procedure may also have their prostate and seminal vesicles removed.
It’s a minimally invasive version of a radical cystectomy performed with a robotic device. During the procedure, the surgeon sits in a console and manipulates the instruments used to complete the surgical removal of the bladder and certain nearby structures remotely.
How Is It Performed?
Performed under general anesthesia, a robot-assisted radical cystectomy is done with smaller incisions than what’s necessary with open surgery and special instruments. The technology behind this type of surgery has evolved to the point where both parts of the procedure, removal and urinary diversion, can be performed within the body.
Several smaller incisions are made to allow for the removal of the bladder and the other urinary structures and the insertion of the instruments. Guided by the surgeon’s hand movements, the robotic arm uses very precise motions to remove the bladder and lymph nodes. The other organs that need to be removed are also taken out.
The reconstruction part of the procedure involves some type of restoration of the urinary tract. If an ileal conduit is created, part of the small intestine is used to make a tube that’s linked to the ureters. The kidneys are attached to an opening created in the abdominal wall. This will result in a constant flow of urine. A bag is attached to the opening (stoma) to collect the urine.
When a neobladder is created, a part of the small intestine is used to create a pouch that will serve as a new bladder. A catheter is sometimes needed to help empty the newly created bladder. Some patients develop issues with urinary incontinence with this type of reconstructive surgery.
Another option is a continent urinary reservoir. The pouch for the urine is created in the abdominal wall with a piece of intestine tissue. A catheter will need to be used and drained periodically. This is an appealing option for patients wishing to avoid using a bag.
What to Expect
The return of normal urine flow and patterns could take several weeks, depending om whether an ileal conduit or neobladder was created. Men may not be able to have a erection, although it will still be possible to have an orgasm. Women may not be able to have intercourse until vaginal tissue relaxes and lengthens. Since the instruments used during robot-assisted surgery can be manipulated in ways not capable by human hands, there is less risk of unintentional nerve damage.
Follow-up care after a robot-assisted radical cystectomy typically includes periodic examinations of the urinary system. Men may be encouraged to have regular prostate exams to look for signs of cancer in this gland. It usually takes about two months to recover from the surgery itself. Dietary suggestions might include eating smaller portions, having meals more frequently, and drinking plenty of water. Patients having any type of bladder removal surgery and subsequent reconstruction are often encouraged to seek emotional support throughout the process.