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Robotic Cystectomy
Da Vinci Robotic Cystectomy (also known as Robotic Assisted Cystectomy) is the most advanced method of performing Cystectomy. This minimally invasive procedure coined its name from the Da Vinci© Robot, which is manufactured by “ Intuitive Surgical.” The Robot combines the latest achievements in medical technology and laparoscopy including:
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Surgeon’s console and patient side cart
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High-performance InSite® Vision System
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Proprietary EndoWrist® Instruments
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- Ergonomically designed surgeon’s console
While sitting comfortably at the console, the surgeon operates while viewing a 3-D color image of the surgical field.
- Patient-side cart with four interactive robotic arms
(three instrument arms and one endoscope arm)
Endowrist instruments execute the surgeon's commands through the key-hole port sites in the patient's abdomen. Surgical team members assist the surgeon by properly installing the Endowrist instruments.
- High-performance InSite® Vision System
with high-resolution 3-D endoscope provides real-time 3-D images of the operative field, with magnification of 12-15 times. This advanced technology spares nerves and delicate tissues during the operation, which plays an important role in patients’ fast recovery and maintenance of the patients' sexual and urinary function.
- Proprietary EndoWrist® Instruments
The instruments are designed with seven degrees of motion that mimic the movements of the human hand and wrist. All movements of the surgeon hands are translated into precise movements with micro-instruments.
Treating Bladder Cancer
Invasive cancer can be highly dangerous and needs to be treated aggressively. A new diagnosis of invasive bladder cancer requires a metastatic survey with a CT scan, bone scan, and chest x-ray. Some blood work may also be performed. If the bladder cancer appears to be confined to the bladder then the standard treatment for invasive bladder cancer is a radical cystectomy. Radical cystectomy is a major operation with significant risk of blood loss and blood transfusion as well as significant risk of heart attack, stroke, and pulmonary embolism. Radical cystectomy also requires a reconstruction of the remaining urinary tract (the upper tracts) so that the urine can drain out of the body in the absence of the bladder. This urinary reconstruction usually involves creating an ileal diversion which is using a piece of small bowel to create a loop that drains urine to a bag on the abdomen. Small bowel could, alternatively, be used to reconstruct a new bladder for certain patients. If you're a candidate for this “neobladder" using bowel and you are interested in such a diversion and you require radical cystectomy we would most likely refer you to a urologist who routinely performs these procedures. These neobladders have a high degree of complications and must be created and managed by someone who performs these procedures very often. Radical cystectomy involves complete removal of the bladder and prostate in the male and in the female radical cystectomy involves complete removal of the bladder, the female pelvic organs, and part of the vagina. There is usually a seven to ten day stay in the hospital if there are no major untoward events during the postoperative recovery. Most patients experience some small or even major setback during the recovery period of a radical cystectomy. Such a setback might include any of the serious consequences mentioned above or a delay in the healing process to slow the recovery of bowel function or a wound infection or a ureteral stricture (a narrowing of the ureter where it connects to the ileal diversion) or pneumonia or some other type of difficulty that delays the recovery process.
If invasive bladder cancer has spread beyond the bladder chemotherapy and possible radiotherapy may be used as additional therapy. In some cases radiotherapy and chemotherapy and TURBT can be used (without radical cystectomy) to manage invasive bladder cancer. This management option is called bladder salvage therapy and is usually consider suboptimal therapy in comparison to radical cystectomy. Bladder salvage therapy is often considered for patients who have invasive bladder cancer but are also high risk surgical patients.
Some cancers invade the lamina propria but do not clearly invade the deeper muscle and connective tissue. These lesions are called T1. T1 lesions are controversial in their management. Most T1 lesions are managed by BCG intravesical therapy as described above but some patients might opt to treat a T1 lesion with radical cystectomy. The rationale for such aggressive treatment of a T1 lesion is based on the possibility that a T1 lesion might actually be an invasive cancer. Studies of patients who have had a T1 lesion who went on to have radical cystectomy showed that their surgical pathology showed invasive cancer 20-25% of the time. So patients with a T1 lesion are at risk for having an invasive cancer or developing an invasive cancer and so they could consider radical cystectomy for treatment. Choosing between radical cystectomy versus BCG intravesical therapy for TI bladder cancer is a very difficult decision for patients.
Radical Cystectomy and Ileal Conduit Diversion can be performed by laparoscopic technique with robotic assistance. Dr. Schanne is the only urologist in Delaware and one of the few urologists in the United States offering this treatment option for bladder cancer. Performing the bladder removal laparoscopically greatly reduces blood loss and speeds recovery. |
