If you are a man and have bladder cancer,
your doctor may recommend a robotic radical cystectomy to remove your bladder and prostate gland.
Your bladder is located in your pelvis, behind your pubic bone.
Your kidneys make urine, which travels down the ureters to your bladder,
where it is stored until you are ready to urinate.
Your prostate gland is located just beneath your bladder.
Passing through your prostate is the urethra, the tube through which urine exits your body.
Each of your vas deferens combines with a seminal vesicle to form an ejaculatory duct, which attaches to your prostate gland.
The innermost layer of your bladder is called transitional cell epithelium, or urothelium.
Transitional cell or urothelial carcinoma, the most common type of bladder cancer,
begins in this layer when an abnormal cell grows out of control.
As the cancer cells multiply, a tumor forms.
The tumor may form a lump inside your bladder, or invade deeper into the bladder wall.
Before your procedure, an intravenous line, or IV, will be started.
You may be given antibiotics through the IV to decrease your chance of infection.
You will be given general anesthesia.
A breathing tube will be inserted through your mouth and down your throat to help you breathe during the operation.
A foley catheter will be inserted into your bladder to drain urine.
Your surgeon will make a small incision near your belly button, and insert a plastic tube called a port.
Carbon dioxide gas will be pumped into your abdomen through this port.
The gas will inflate your abdomen, giving your surgeon more room to see and move the surgical tools.
After your abdomen is inflated, a high-definition camera will be inserted into this port.
Your surgeon will make additional port incisions for robotic instruments as well as for instruments used by patient-side assistants.
An assistant will insert all of the robotic tools through these ports.
Unlike standard laparoscopic instruments, these tools can rotate 360 degrees, and have more flexibility than the human wrist.
Seated at a special console,
your surgeon will operate the robotic arms and the camera with “joystick-like” controls and foot pedals.
A computer will translate the exact movements of your surgeon’s fingers into precise movements of the surgical tools.
At the same time, a high definition vision system will provide a magnified three-dimensional stereoscopic view of the surgical area.
With the robotic arms in position, your surgeon will cut both ureters near their connection to your bladder.
Each vas deferens will be cut.
Then, your surgeon will cut your urethra just beneath your prostate.
These cuts free your bladder and prostate so they can be removed.
Lymph nodes near your bladder and prostate will also be removed to determine if your cancer has spread.
Since your bladder has been removed,
your surgeon will need to reconstruct a new pathway for you to pass urine from your body.
Your surgeon will create this new path using a section of your small intestine in one of three ways.
If you receive an ileal conduit,
one end of the intestinal section will be attached to the surface of your abdomen, called a stoma.
Your surgeon will seal the other end and attach your ureters to it.
Your urine will drain into a bag attached to the stoma.
If you receive a continent reservoir, your surgeon will make an expanded pouch from a section of your intestine.
Your urine will drain through a catheter in the stoma.
If you receive a neobladder, or bladder substitute,
your surgeon will make a reservoir from a section of your intestine and place it where your bladder used to be.
Your surgeon will connect the top of this new bladder to your ureters, and the bottom to your urethra.
You will urinate by contracting your abdominal muscles, which will create pressure on your neobladder so it will empty.
At the end of your procedure, the tiny incisions will be closed with stitches, staples, surgical glue, or closure-tape dressings.
After the procedure, your breathing tube will be removed and you will be taken to the recovery area for monitoring.
You will be given pain medication as needed.
You may continue to receive antibiotics through your IV.
Most patients are released from the hospital seven to ten days after the procedure.
If you received a neobladder, your catheter will be removed about seven days after the procedure.