Treating bladder cancer with robotic surgery

In some patients, treatment for early bladder cancer that involves transurethral resection of the bladder tumour (TURBT) followed by chemotherapy or immunotherapy, is not successful. Not all of the tumour may be removed or destroyed. If the bladder cancer continues to advance, your best treatment option may be to remove the entire bladder.

Traditionally, bladder removal, an operation known as a cystectomy, was done by open surgery. This involved making an incision into the abdomen and removing the bladder. It was an operation associated with loss of blood, nerve damage, a significant rate of infection and other complications.

Bladder removal using the da Vinci® robot

The advantages of using robotic surgery to remove and reconstruct a bladder include a faster recovery time for the patient, less chance of complications such as infections or blood loss, and a better outcome.

The 3-D, high definition camera and screen used in robotic surgery allows the surgeon to see the bladder and the nerves and blood vessels that are attached to it in much greater detail. The flexible instruments, which can move naturally because of the Endowrists®, enable the surgeon to work around nerves, blood vessels and muscles that are important for function after the operation.

Who can benefit from robotic bladder removal?

Robotic cystectomy is particularly suitable for patients with bladder cancer that has invaded the muscle of the bladder or those aggressive cancers that fail to respond to traditional treatment such as transurethral resection of the tumour (TURBT) and chemotherapy or immunotherapy (BCG), even when infused directly into the bladder. These are patients whose cancers would spread if their bladder was not removed completely.

Life after bladder removal

Removal of the bladder for cancer involves the removal of the bladder and prostate in men and the bladder with the uterus and ovaries in women. After bladder removal, various options are available to allow urine to pass out of the body:

  • An ileal conduit: this operation creates a tube made from a short piece of small intestine. This is connected with the ureters that carry urine out of the kidneys, and is then used to create an opening to the outside of the body. This is a stoma and it needs to be connected to a urine collection bag that is worn on the outside of the body.
  • A continent urinary diversion: part of the bowel is used to reconstruct an internal reservoir for urine. This is connected to the ureters coming from the kidney and it has a stoma to the outside of the body. This can be opened to release the urine using a catheter, which is put in place by the patient. This method provides some control over voiding of urine, but this does not happen by the normal route.
  • An orthoptic bladder: this is the reconstruction of a new bladder using tissue from the bowel. It is positioned where the original bladder used to be, and connected up to the urethras, the tubes that bring urine from the kidneys, and to the ureter, which then takes urine out of the body through the normal route.