Radical Cystectomy

When the bladder cancer has grown or invaded surrounding muscle or tissue surgical management is most likely to be necessary, usually in the form of a cystectomy which is the complete removal of the bladder.

Radical cystectomy involves removal of the entire bladder and in women also the uterus, fallopian tubes, ovaries, anterior vaginal wall (the front of the birth canal), and urethra.

In men, if the prostate and bladder are both removed the procedure is known as Cysto-Prostatectomy.

With a radical cystectomy, removing the bladder and surrounding organs will change the way the body functions. In men, the nerves needed to get an erection are likely to be affected. Women who have their reproductive organs removed will go through menopause if they have not already.

Robotic radical cystectomy is a new advanced laparoscopic (key hole) approach that enables the surgeon to perform complex surgery through tiny incisions, with precision and ease, improving the outcome and reducing complications.

About the Robot

Robotic surgery involves two machines, a control unit or the surgeon’s console and a patient unit. The surgeon sits at the control unit, away from the operating table, and controls the movement of the four robotic arms of the patient unit, present near the operating table. One of the robotic arms holds and positions a 3D high definition camera through the incision in the operated area providing images of the operation site to the surgeon at the control unit. These images are high resolution 3D images, superior to the 2D images in the laparoscopic approach. Moreover, the images can also be magnified by 10 to 12 times. The other three robotic arms are used to hold small miniature instruments, which are used for the surgery. These instruments are introduced through the tiny (7 mm) incisions over the patient’s abdomen. These miniature instruments are more flexible compared to the long handled rigid instruments of the traditional laparoscopic surgery. A wide range of these instruments are available to the surgeon to perform various specialised surgical tasks. 

The robotic arm cannot be programmed to do the surgery on its own. Instead, it translates the surgeon’s hand movements, at the control unit, into precise movements of the micro-instruments in the operation site, minimising tremors that may occur from unintended shaking of the surgeon’s hands. The enhanced vision and superior control of the micro-instruments helps in precise removal of the cancer while limiting damage to the nerve fibres and the blood vessels near it.