Urology Austin

cystectomy

What is a Cystectomy

A cystectomy is a surgical procedure that is used to remove the bladder, prostate, and pelvic lymph nodes. This surgery is indicated for patients with bladder or surrounding cancers, severe inflammatory conditions that have damaged the bladder, or  a congenital (at birth) urinary deformity.

What is a Robot Assisted Radical Cystectomy?

A radical cystectomy  is removal of the entire bladder by way of open surgery, a laparoscopy, or a robot assisted laparoscopy. A robot assisted cystectomy is a procedure in which several small incisions are made in the patient’s abdominal region to give access to robotically controlled surgical instruments. This surgery is different from a open cystectomy in which a large incision is made in the body to remove the bladder. Cystectomy surgery is performed for both men and women, however, the procedure will have variations. Along with removing the bladder, men may also have their prostate gland and seminal vesicles removed. For women, reproductive organs, such as the ovaries, fallopian tubes, uterus, and a section of the vagina, may need to be removed.

Benefits of a Robot Assisted Cystectomy

Robotic surgery gives the surgeon technological advantages including better visualization and magnification of the bladder, surrounding  organs, nerves, and tissue. The robot also gives the surgeon more flexibility and precise maneuvering during the operation. While minimally invasive, this is a major surgery that is performed under general anesthesia.

Robotic assisted surgery  for bladder removal has documented benefits compared to open surgery including: the potential for less pain and blood loss, lower risk of complications, shorter hospital recovery, improved bowel recovery time, and smaller scars at the entry points.

Possible risks and complications

A cystectomy is a major surgery, performed under general anesthesia, that can affect several parts of the urinary and reproductive systems. This surgery also requires a simultaneous procedure for creating a method in which urine can be stored and eliminated. The complexity of this surgery carries potential risks, including bleeding, pain, blood clots, allergic reaction to anesthesia, internal organ damage, sexual dysfunction, and infection. It is important to thoroughly discuss all potential risks with the surgeon prior to having this procedure. The patient will have ureteral stents which will be visible, and the new urostomy (opening for urine to leave the body). These are removed in the office at one of the patient’s post-operative visits.

Prior to surgery

Several days prior to surgery, the patient will undergo pre-operative testing including imaging, blood work and possible cardiac clearance. The surgeon will advise individual patients about the discontinuation of blood-thinning medicines and any other restrictions. It is advised to drink fluids up to three hours before the procedure.

Post-surgery

Following a cystectomy , the patient will be hospitalized – for several days – as their body begins the healing process.  During this period, patients will experience a varying degree of pain / discomfort, possible aftereffects of anesthesia, and significant urinary changes. Medical staff will discuss specific changes, expectations, and protocols for adjusting to bladder / organ removal. The aid of a stoma nurse is standard practice as well as post discharge home health nursing.

Related link

Intuitive Surgical Robot Assisted Cystectomy