Robotic Radical Cystoprostatectomy
Robotic Radical Cystoprostatectomy
Robotic radical cystoprostatectomy (RALC) is a surgical procedure used to treat advanced bladder cancer. During this surgery, the bladder and prostate are removed together. Cystoprostatectomy is usually preferred in cases of invasive bladder cancer that has spread to the muscle layer. The use of robotic surgical systems such as the Da Vinci allows this surgery to be performed less invasively and more precisely.
What is Robotic Radical Cystoprostatectomy?
Radical cystoprostatectomy is a major surgery that involves removing the bladder, prostate, and some surrounding lymph nodes. This surgery is usually performed to treat bladder cancer and restores the patient’s ability to store and excrete urine.
Robot-assisted laparoscopic surgery (RALC) is a minimally invasive surgical procedure in which the surgeon controls laparoscopic instruments using a robotic console. This procedure offers the surgeon greater precision, 3D imaging, and the ability to work through small incisions.
After the bladder is removed, an alternative route (urinary diversion) must be created for the patient to pass urine out of the body. During this procedure, the surgeon reconstructs the urinary tract using various methods.
Robotic Radical Cystoprostatectomy Process
- Anesthesia:
The operation is performed under general anesthesia. The patient is completely asleep and does not feel any pain.
- Opening the Incisions:
Several small incisions are made in the abdomen. Robotic arms, laparoscopic instruments, and a camera are inserted through these incisions.
- Removal of the Bladder and Prostate:
– The surgeon guides the robotic arms through small incisions using a platform such as the Da Vinci robotic system.
– The bladder, prostate and surrounding lymph nodes are removed.
– During the operation, great care is taken to avoid damaging the tissues and nerves surrounding the bladder.
- Urinary Diversion:
Once the bladder is removed, a decision is made on how to direct urine out of the body.
There are 3 main types of urinary diversion:
– Ileal Loop (Ileal Conduit):
It is the removal of urine from the kidneys through an artificial channel (conduit) made using a piece of intestine and through a stoma (hole) opened on the abdomen. Urine is collected in a bag.
– Neobladder (New Bladder):
A new bladder is made using a piece of intestine and connected to the urethra. The patient can continue to urinate naturally.
– ContinentDiversion:
Like the ileal conduit, a reservoir is made from the intestine, but with this method the patient urinates through an opening in the abdominal wall. Urination is controlled and the patient empties this reservoir occasionally with a catheter.
- Completion of the Surgery:
After the bladder and prostate are removed and new urinary tracts are created, the robotic arms are removed and the incisions are closed.
Advantages of Robotic Cystoprostatectomy
Robotic radical cystoprostatectomy offers several advantages over traditional open surgery:
- Minimally Invasive:
– It is performed with small incisions and is less traumatic than open surgery.
– Provides less pain and faster recovery.
- More Precise Surgery:
– The surgeon sees the surgical area more clearly thanks to the high-resolution, three-dimensional images provided by the robotic system.
– Robotic arms exactly mimic the surgeon’s hand movements and enable more precise incisions to be made.
- Less Blood Loss:
– Thanks to the small incisions and minimally invasive techniques made during robotic surgery, blood loss is less.
- Fast Recovery:
– Smaller incisions and minimally invasive techniques allow patients to recover more quickly. Hospital stays are usually shorter and patients can return to their daily activities more quickly.
- More Effective Removal of Lymph Nodes:
– The precision of robotic surgery allows for more complete removal of lymph nodes, reducing the risk of cancer spreading.
Disadvantages and Risks of Robotic Cystoprostatectomy
Like any surgical procedure, robot-assisted laparoscopic radical cystoprostatectomy carries some disadvantages and risks:
- Cost:
– Robotic surgical systems are costly devices, which can increase the cost of the surgery.
- Technical Difficulties:
– Robotic surgery requires experienced surgeons. For inexperienced surgeons, the surgery time may be longer and the risk of complications may increase.
- Postoperative Complications:
– There may be complications such as urinary incontinence and loss of sexual function. However, these risks vary depending on the experience of the surgeon.
- Infection and Wound Complications:
– As with any surgical procedure, infection and wound healing complications can occur.
The Healing Process
Recovery from robot-assisted laparoscopic radical cystoprostatectomy is usually faster, but the patient may require long-term care and follow-up. The following points should be kept in mind during the recovery process:
- Catheter Use:
If an artificial bladder is used, a Foley catheter is inserted after surgery to allow the urinary tract to heal. This catheter is usually removed a few weeks after surgery.
If an ileal conduit has been placed, the catheters attached to the kidney are removed within 7-10 days.
- Urine Control:
Urinary incontinence can be a common complication after surgery. Most patients regain urinary control over time, but this can range from a few weeks to a few months.
- Sexual Function:
Removal of the prostate and surrounding nerves can cause loss of sexual function. If nerve-sparing methods are used, sexual function can be restored, but this process can take time.
- Physical Activity:
Patients can usually return to light daily activities within a few weeks, although strenuous physical activities such as heavy lifting may need to be avoided.
Conclusion
Robotic radical cystoprostatectomy is an effective surgical method in the treatment of bladder cancer. The advantages of robotic surgery, such as minimal invasiveness, high precision and rapid recovery, make this method more preferred than traditional open surgery. However, this surgical method also has some disadvantages such as cost and technical difficulty. The type of surgery for each patient should be decided by considering the stage of the disease, the experience of the surgeon and the general health of the patient.