Laparoscopic / Robotic Cystectomy
Radical Cystectomy is the gold standard treatment for invasive bladder cancer. To date, here at Weill Cornell-New York Presbyterian Hosptial, we have one of the largest experiences in robotic-assisted radical cystectomy.
We have performed over 100 robotic cystectomy procedures to date. In most instances, we have been able to create internal bladders and maintain urinary continence and erectile function while at the same time maximize cancer cure rates. Although most often it is necessary to remove the entire bladder, we have been able to pursue bladder sparing approaches with the use of intravesical agents such as BCG and interferon. In addition, we are pioneering novel agents in our urological oncology research labs that will likely replace current therapies and therefore maximize bladder sparing treatments.
Radical cystectomy entails removal of the bladder, prostate, seminal vesicles, and surrounding fat peritoneal attachments in men, and in women, also the uterus, cervix, urethra, anterior vaginal wall, and usually the ovaries. Pelvic lymph node dissection is performed concurrently. Although this is standard, we have now begun to explore several less invasive techniques, including vaginal sparing surgery in which cancer cure rates are not compromised in select patients.
Partial cystectomy removes areas of the bladder where cancer is found. This allows for non-cancerous parts of the bladder to be preserved. Often combined with either intravesical immunotherapy or systemic chemotherapy, this approach can be quite effective in very select patients.
Robotic-Assisted Cystectomy/da Vinci Robotic Cystectomy
Though a cystectomy can be performed with traditional open surgical methods, they typically involve more tissue and nerve damage, necessitate more blood loss and carry a greater risk of post-operative infection. By comparison, robotic-assisted laparoscopic cystectomy (also known as da Vinci cystectomy) is a type of minimally invasive surgical method that makes use of robotic equipment that imitates a surgeon's movements, only with greater precision, thereby offering patients improved outcomes. This has become the preferred surgical answer to bladder cancer at our institution in select patients. The procedure is performed using the da Vinci system, the only robotic surgery approved by the FDA. We have performed a head-to-head study recently published in an international urology journal that has shown equal efficacy of the robotic cystectomy, yet with improved quality of life issues and shorter hospital stay.
Minimally invasive surgical techniques allow urologists to operate via smaller rather than larger incision ports; this results in faster recovery times, fewer complications and shorter hospital stays.
Just as with a traditional open cystectomy, the robotic procedure requires urinary diversion then reconstruction after the bladder has been removed for both men and women. There are three basic types of urinary diversions. First, there is the ileal conduit with the main advantage being its simplicity, but with the obvious disadvantage of having to wear an external appliance. Second we could construct an orthotopic neobladder. In this case the bladder is all internal and attached back to the urethra so the patient can urinate normally. This can be done in both men and women. This is an obviously more complex operation with a longer, more labor intensive post-operative course requiring the patient to be discharged for several weeks with temporary drainage bags. However, there is the advantage of voiding through the urethra. The third option is the continet cutaneous urinary diversion. This would require self catheterization through the belly button. Determination of the most appropriate type of urinary diversion is based on personal and individualized attention at the time of your consultation.
- Requires key-hole incisions distributed throughout the abdomen.
- The procedure is tailored to spare both nerve and muscle.
- 4 to 7 day post-operative hospital stay.
- There will be less blood loss, and therefore minimal chance of a blood transfusion.
- Reduced surgical scarring, less discomfort and therefore less need for pain medication.
- 6-8 weeks of recovery time before returning to a normal, but non-taxing, quality of life.
Benefits of Robotic-Assisted Cystectomy:
- Significantly reduced morbidity.
- Shorter hospital stays and a faster return to your normal activity level.
- Less tissue and nerve damage.
- Fewer noticeable scars.
- Less blood loss.
- Reduced risk of infection.
- Reduced risk of incontinence and impotence.
- Lower chance of other complications.
- Less post-operative pain and discomfort.
- The advantage of the da Vinci robotic system's 3-D visualization, offering surgeons a definitive view of the procedure, as well as robotically accurate suturing and stitching.
If you'd like more information on Dr. Scherr's medical expertise and leading-edge da Vinci robotic technology, please don't hesitate to contact his office.