A robotic cystectomy is a minimally invasive procedure that is used to treat diseases of the urinary bladder requiring partial or complete removal of the bladder. Radical cystectomy is done when the urinary bladder has cancer, and it has spread to the muscle wall. Smaller incisions are made compared to open cystectomy, in which a significant incision helps remove the entire bladder.
Robotic surgery is one of the recent advancements in treating cancers. Robotic cystectomy benefits from the robot's arms and allows for greater flexibility than traditional laparoscopic methods. This greater flexibility permits the surgeon to accomplish complex tasks like internal stitches meticulously in the form of urinary diversion or neobladder. Additionally, the robotic platform provides the surgeon with a 3D high-definition view of the inside of the abdomen. This enhanced vision helps with precision.
When is the Robotic Cystectomy Procedure Needed?
A robotic partial cystectomy is indicated in cases where cancer only affects a part of the bladder, or the patient has noncancerous bladder diseases. However, for major cases, radical cystectomy is required. Robotic surgery permits minor invasion and faster healing. Hence, it can be done in patients with diabetes and other medical conditions with caution.
Who is the ideal patient for Robotic Cystectomy?
Robotic cystectomy is indicated for patients with:
- Bladder cancer that has invaded a part of the urinary bladder
- Pelvic cancers such as colon and endometrial involving the urinary bladder
- Developmental abnormalities of the bladder requiring simple cystectomy
- Fistula between vagina or colon and bladder requiring partial cystectomy
- Bladder diverticula may require diverticulectomy/partial cystectomy
- Pheochromocytoma or schwannoma of the bladder /Cavernous hemangioma or Localized endometriosis of the bladder requiring partial cystectomy
Who should not consider Robotic Cystectomy?
Robotic cystectomy is contraindicated in patients with:
- The presence of dense intra-abdominal adhesions
- Patients intolerant to pneumoperitoneum
- Patients who cannot assume the Steep Trendelenburg (ST) position
- Medical comorbidities such as heart disease, advanced age, poor pulmonary mechanics/Bleeding disorders
- Evidence of metastatic disease / Advanced stages of cancer
How to prepare for Robotic Cystectomy?
A meeting with the surgical team is scheduled to discuss the patient's history in depth and evaluation of disease. The urologist may advise Cystoscopy to view the internal part of the bladder and perform a biopsy and imaging studies like CT scan/MRI /PET CT scan to evaluate the tumour size, shape, and extent of disease.
The urologist also advises certain blood tests and imaging scans such as a chest X-ray or an electrocardiogram (ECG), Echo to evaluate any other underlying medical condition. The family history is assessed to prevent anaesthetic complications.
At the consultation visit for the surgery, the doctor shares details of the procedure and answers queries. Then, the doctor gives the postoperative instructions to follow. A consent form for the surgery is signed at this appointment.
- Before the operation, the doctor stops certain medications such as blood thinners and NSAIDs.
- Avoid smoking and drinking since they interfere with the surgical procedure.
- Jewelry, metallic objects, or other objects that may interfere with the surgery are removed.
- Empty the bladder before the procedure.
- Follow fasting for 6 to 8 hours before the surgery to avoid the side effects of anaesthesia.
- Patients are often admitted a day before assessing vitals and injecting pre-operative medicines such as antihypertensives and antibiotics.
What happens during a Robotic Cystectomy procedure?
Robotic cystectomy can be performed under general anaesthesia. The surgeon operates through the robotic console and controls the surgical instruments via robotic arms. Once anaesthesia is in effect, the operating surgeon makes incisions or minor cuts over the abdomen and makes provision for the robotic laparoscope to enter the surgical site. The laparoscopic probe carries a small camera and the surgical instruments required to carry out the procedure. On entering the abdomen, it is inflated, and everything inside is projected onto television screens.
The surgeon uses robotic instruments and removes cancerous tissues from the lymph nodes, bladder, and surrounding areas that look suspicious. If urinary tract reconstruction is indicated, the surgeon may decide to do it in a traditional open fashion or with robotic assistance based on the condition.
The robot enables extreme precision and reduces postoperative patient discomfort significantly.
Risks/Complications after Robotic Cystectomy
Robotic cystectomy is a minimally invasive procedure but comes with its own set of risks and complications, which include:
- Blood clots
- Neighbouring Organ damage
- Reactions to anaesthesia
Patients may also experience changes in passing urine after the surgery. Since the bladder reduces in size after the partial cystectomy, the patient may feel the urge to urinate frequently. In addition, sexual side-effects may be seen in some patients, such as maintaining erections (erectile dysfunction) and discomfort while having coitus. This happens because, during the surgery, the seminal vesicles and prostate may need to be removed; thus, these men may never produce semen.
In women, intercourse is possible but may cause discomfort if part of the vagina is removed. This is because the nerves may be affected, which causes arousal and orgasm.
Care after Robotic Cystectomy
After the robotic cystectomy procedure, the patient is moved to the recovery room. Here, their vitals are monitored, and once stable, the patient is transferred to the standard room.
Following the guidelines explained by the operating surgeon after the surgery is essential for the best postoperative care. One must timely schedule follow-up appointments for proper evaluation of results from the surgery. It is necessary to follow the doctor's protocols for taking the medicines. Some pain during early recovery can be expected.
When recovering at home, the following can be expected:
- Patients are informed that returning to a regular diet should be gradual. This helps prevent the ill effects of anaesthesia. This can be done by consuming liquids at first and slowly moving to a semi-solid and solid diet.
- Keep the incision areas dry for the following few days. It is essential to follow the surgeon's guidance on bathing as well as dressing the wound. The possibility of returning to the operating doctor to manage the sutures is common. This is most often done to remove them and to inspect the healing of the wound.
- Lifting heavy belongings should be avoided after the surgery. This should be followed for a few weeks. Also, ask the surgeon when specific activities can be returned to.
- Complete recovery may take a few weeks. Sometimes even a few months.
After robotic cystectomy, if any of the following are experienced, it is essential to contact the doctor immediately.
- Signs of infection like fever and chills
- Heavy bleeding
- Increase in redness, swelling, pain, or discharge from the surgical area
- Nausea and vomiting that will not stop
- Difficulty urinating or draining urine from your urinary reconstruction
- The pain you are unable to control with medications you are given
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