Robotic Surgery for Urinary Bladder Cancer

Robotic surgery for urinary bladder cancer is a minimally invasive procedure wherein robotic instruments assist the surgeon in removing lymph nodes and the urinary bladder - the hollow muscular part of the urinary system that stores urine. Robotic surgery is ideal for high-risk muscle-invasive and non-muscle-invasive cancers. It is preferred over laparoscopic and open surgeries as it offers a similar success rate, better precision, less pain, less blood loss and quick recovery. Robotic surgery has become the gold standard for surgery for bladder cancers and also for urinary diversion following removal of the bladder, whether an ileal conduit or a neo bladder can be all done robotically without having the need to make any incisions on the body.

Alternate Name

Robotic Radical Cystectomy with urinary diversion (Ileal conduit/Neobladder)

Body Location

Urinary Bladder / Pelvis

How it is Performed

Robotic cystectomy is performed under general anesthesia and you will be asleep throughout the procedure. A safe volume of carbon dioxide (CO2) is used to inflate the stomach to have enough working space for the surgeon. Minor cuts are made in the abdomen to insert various surgical tools, including robotic arms and a highly-magnified camera. The surgeon uses a surgical console to control robotic arms and a camera to create high-definition visuals on the computer screen. These visuals are 3-dimensional and aid the surgeon in examining the affected tissue precisely without disturbing the other sensitive nerves and tissues. The surgeon removes the urinary bladder and associated tissues and lymph nodes with the robotic arms.

Following the removal of the urinary bladder, the surgeon will reconstruct the urinary tract to get urine excreted from your body. In case of complete bladder removal, reconstruction of the urinary bladder can be done by three methods, viz. ileal conduit, continent cutaneous diversion, and neobladder, using the small or large intestine portions.

Preparation

Before undergoing urinary bladder cancer surgery, your doctor will recommend certain blood tests such as CBC (complete blood count), INR (International Normalized Ratio), urine culture, and routine urine examination. You will also need to get an electrocardiogram (ECG) and a chest X-ray. Then, you will undergo a pre-anesthesia checkup (PAC), where a doctor will assess your suitability for the procedure. Your surgeon will also order an imaging test, such as a CT scan to identify the cancer location and plan the surgical procedure.

You will need to inform your doctor if you are on any medications. They might advise you to discontinue specific medications such as blood thinners, aspirin, etc., as these are linked with blood loss during surgery. You will also be given anti-anxiety medication to relax. You should quit alcohol and tobacco use (especially smoking) to avoid complications.

You will be advised not to eat or drink anything post-midnight the day before the surgery. You should reach the hospital at least 4-6 hours before the surgery and you will be kept under observation for some time before preparing for the surgery.

Procedure Type

Minimally invasive surgery

Follow-up

You will be given a follow-up schedule/chart and you should visit your surgeon for all the follow-ups to ensure a complication-free recovery. Take special care to keep the incisions clean and you may use soap and water to wash gently. Do not rub the incisions and dry them by patting them with a soft clean cloth. You should avoid using the bathtub or swimming pools as these could lead to infections or excessive pressure on the incisions.

You should start with light physical activity after the surgery, such as walking and you can increase the distance slowly as you gain strength. However, you should avoid strenuous activities such as cycling, running, jogging, lifting weights, etc for at least 3 months. You should climb up and down the staircase, but the movement should be slow. Physical activity will help you recover quickly, but you should make sure not to overexert yourself and take plenty of rest and sleep.

Avoid excessive bending as it will exert abdominal pressure and discomfort. Seek help from friends and family members. If you need to pick something, bending on the knees is a better option to avoid discomfort. You should avoid driving for around 4 weeks, as suggested by your doctor. Also, avoid long road trips. If you must, take breaks and walk around for some time before resuming the journey.

Risks

Although robotic surgery is more efficient and safer than traditional surgery; however, being a major surgery, robotic cystectomy is also associated with the following risks:

• Incision site infections could occur and you might require antibiotic treatment.
• Bleeding and blood loss can occur in the case of complex procedures.
• Damage to the adjoining or nearby organs/tissues, such as the urethra, uterus in females, penis in males, etc., could occur, requiring further medical intervention.
• Blood clot formation could occur.
• Hypersensitivity to anesthesia is another potential side effect in sensitive individuals.

In addition, robotic surgery could be associated with the following side effects:

• Inability to maintain an erection in males.
• Inability to produce semen due to removal of seminal vesicles and prostate during surgery.
• Difficulty in arousal and getting orgasms in females due to disturbance of the associated nerves.

Recovery

Following the surgery, you will be under active monitoring. You will be shifted to the recovery room within a couple of hours to days, depending upon the complexity of the surgery. Based on your overall health and stability of vital parameters, you will be discharged from the hospital within a few days while the bladder tube (catheter) is still placed. You will be required to visit your surgeon after around 3 weeks to get the catheter removed. Following catheter removal, your doctor will examine for any signs of infection, voiding frequency, etc., to ensure deviation-free recovery.

The recovery may take up to 3 months and you may start returning to your routine activities. During the recovery phase, good care is required and you should avoid heavy work for a few months. Regular follow-ups are critical to an event-free recovery, as your surgeon will be able to monitor your progress. You might experience abdominal discomfort, constipation, etc., for a few weeks. Drink plenty of fluids and increase your intake of fibrous foods to help in bowel movement. Take healthy and nutritious food to aid in quick recovery. Take your medications as prescribed by your surgeon and avoid self-medication for quick relief. Always look for signs of complication and seek immediate medical attention if required.