Robotic cystectomy is a minimally invasive surgical procedure used to remove part or all of the bladder.
It is most commonly performed to treat bladder cancer, but may also be recommended for certain neurological conditions or congenital abnormalities affecting the urinary system.
Understanding the Bladder
The bladder is a muscular sac located in the pelvis, roughly the size of a pear when empty, and can hold 400–600ml of urine when full. It receives urine from the kidneys and stores it until excretion.
Types of Cystectomy
Partial cystectomy removes only the affected area of the bladder, preserving as much healthy tissue as possible. This is usually an option when cancer is detected early and has not invaded the muscle layer.
Radical cystectomy involves removal of the entire bladder and surrounding tissues, which may include nearby lymph nodes, the urethra, and reproductive organs. In men, this can include the prostate and seminal vesicles; in women, the uterus, ovaries, fallopian tubes, and part of the vagina may also be removed.
What Is Robotic Cystectomy?
Robotic cystectomy uses small, computer-controlled instruments attached to a robotic system to perform surgery with high precision. The surgeon controls the robotic arms from a console, which allows for enhanced dexterity and visualization. This method has become the preferred approach for treating bladder cancer due to its accuracy and minimally invasive nature.
How the Procedure Works
The surgery begins with several small incisions in the abdomen. Through these, a camera and robotic instruments are inserted to detach the bladder. Once removed, the urinary tract is reconstructed to restore normal function. Reconstruction options include:
- Orthotopic continent urinary diversion: A portion of the intestine is used to create a new reservoir connected to the urethra, allowing near-normal urinary function.
- Urinary conduit (urostomy): A piece of intestine is used to create a passage from the kidneys to the abdominal wall, where a bag collects urine.
The type of reconstruction depends on the patient’s health, preferences, and reason for surgery.
Advantages of Robotic Cystectomy
Robotic cystectomy offers multiple benefits over traditional and laparoscopic surgery:
- Shorter hospital stays
- Less pain and scarring
- Reduced blood loss and infection risk
- Greater precision, improving preservation of surrounding tissues
- Lower risk of complications such as incontinence or sexual dysfunction
Risks and Side Effects
As with all surgeries, risks exist. These may include infertility, erectile dysfunction, issues with urinary reconstruction, or scar tissue formation. However, robotic surgery reduces the likelihood of many complications compared to open procedures.
Recovery After Surgery
Recovery is typically faster than traditional surgery. Most patients stay in hospital for 4–7 days, gradually moving from liquids to solid food, and are encouraged to walk early to prevent complications. Full recovery, including regaining bladder control, usually takes 1–3 months. Strenuous activity and driving should be limited during this time.
Robotic Cystectomy with Dr. Arianayagam
Dr. Arianayagam, trained under leading urologist Dr. Murugesan Manoharan at the University of Miami, specialises in robotic bladder and prostate surgery. He performs robotic procedures at Macquarie University Hospital and Nepean Public Hospital, and also mentors other surgeons in the use of the Da Vinci Robotic System.
For more information or to schedule an appointment, contact Dr. Arianayagam’s office on 1300 307 990.
