A cystectomy is a surgical procedure used to remove either part or all of the bladder, usually in order to treat bladder cancer, or neurological conditions affecting the urinary system and birth defects that affect the urinary system.
The bladder is a muscular sac located in the pelvis. It is roughly the size of a pear when empty with a capacity anywhere between 400ml and 600ml when full. It receives urine from the kidneys and stores it for excretion.
There are two main types of cystectomy:
A partial cystectomy removes only the areas of the bladder where cancer is found. This allows for the remainder of the bladder to be preserved.
A radical cystectomy involves removal of the entire bladder including nearby lymph nodes, part of the urethra and any other nearby tissue that may contain cancerous cells. In men, the prostate, urethra and seminal vesicles may also need to be removed. In women, the urethra, uterus, ovaries, fallopian tubes and a portion of the vagina may also be removed.
Robotic cystectomy is a surgical method for operating on the bladder using small tools that are attached to a robotic system. It is a far more effective, minimally invasive procedure. Basically, rather than the surgeon performing the procedure with their own hands, they control robotic arms with a computer which mimic the movements of the surgeon. Robotic cystectomy is become the preferred method for treating bladder cancer.
A robotic cystectomy is performed by a surgeon sitting at a computer station who directs the movements of the robotic arms via a computer interface.
The robot’s camera and instrument-bearing arms are inserted through several small incisions in the abdomen. The bladder is detached internally, then removed through one of the incisions.
If the bladder is removed entirely, the urinary tract will need to be reconstructed in order for proper urinary function to return. This may involve a number of procedures:
Orthotopic continent urinary diversion – a piece of the intestine is used to create a tube that runs from the kidneys to a small reservoir which is connected to the urethra. This allows close to normal urinary function.
Urinary conduit (urostomy) – a piece of the intestine is used to create a tube that runs from the kidneys to the abdominal wall. A bag worn on the abdomen is used to collect the urine.
The reconstructive procedure used will depend on a few factors including the reason for surgery, your health, and your personal preferences. Read more about urinary diversion here.
Robotic cystectomy has a number of advantages over traditional surgery, even laparoscopic surgery. Firstly, the technology used in robotic surgery enhances precision, control and flexibility of the surgeon’s movements. The robotic arms have seven degrees of freedom, which means they can move in more ways than the human wrist.
Robotic surgery also provides high definition, three-dimensional vision which allows the surgeon to distinguish vital muscles, and tissue surrounding the bladder, increasing the chance of preserving them.
Advantages of robotic cystectomy include:
• A much shorter stay in hospital
• Decreased pain and minimal scarring
• Less blood loss and lower risk of infection
• Minimised chance of postoperative incontinence, impotence and other complications commonly associated with a cystectomy.
As with any surgery, there are risks associated with robotic surgery. However, the technique is very safe compared to open surgery and is now considered the gold standard that all techniques are measured against.
Side effects of robotic cystectomy include infertility (if a woman’s uterus or ovaries, or a man’s prostate gland is removed during the surgery), erectile dysfunction and premature menopause, issues with the reconstructed urinary tract, or scar tissue forming in the intestine.
However, it must be noted that robotic surgery dramatically decreases the risk of many of these side effects.
Recovery time after a robotic cystectomy is much shorter than open surgery or even laparoscopic surgery.
Following the procedure, patients are taken to recovery and monitored closely. A brief 4-7 day stay in hospital is usually required.
Once stable, patients can drink liquids. This will progress to a more advanced diet as their condition improves. Patients are encouraged to begin walking a soon as possible to help prevent complications.
Once home, patients are encouraged to stay active, although strenuous exercise, heavy lifting or excessive stair climbing is not recommended for at least 6 weeks. Driving is discouraged for 3-4 weeks after surgery.
Overall, recovery time is reduced to between 1 and 3 months after surgery, including acquiring full bladder function and control.
Dr Arianayagam is an expert in robotic surgery and performs all radical cystectomies with the Da Vinci robot system. He also performs the urinary diversion (conduit or neobladder) inside the body (intracorporeal).
Patients may have their robotic cystectomy performed at either Nepean public hospital or Macquarie University Hospital.
Dr Arianayagam is a proctor for Device Technologies, who supply the Da Vinci Robotic System in Australia. Being a proctor means Dr Arianayagam is qualified to teach other surgeons to use this technique.