Robotic Cystectomy - RARC | MedStar Health

Robotic cystectomy is a minimally invasive surgical method to treat bladder cancer. This procedure utilizes the da Vinci Surgical system in which a robotic arm imitates the surgeon’s movements, amplifying their precision. It offers bladder cancer patients the prospect of a more effective surgery and less problematic post-surgical recovery. This surgical procedure allows the surgeon to make smaller incisions which spare vital, but delicate, nerve and muscle tissue. The patient experiences a shorter hospital stay, fewer complications, and a faster recovery time.

Similar to a standard laparoscopic cystectomy, the robotic-assisted cystectomy may require a urinary diversion with subsequent reconstruction for the removed bladder. For men and women alike, such reconstruction would include a continence reservoir which holds urine in the abdominal cavity until the patient has been fitted with a catheter to empty urine or a bladder replacement and an external bag for urine collection. The da Vinci Surgical System provides the physician with a superior visualization plane and improved surgical dexterity during bladder removal and, if necessary, a reconstructive procedure.

By offering the surgeon, urologist or oncologist a high-definition 3-D view, the da Vinci surgical robot distinguishes the vital muscles and delicate nerve tissues surrounding the operative area, providing the opportunity to preserve them. The robot’s unique EndoWrist instruments offer physicians the dexterity not available to them when using conventional laparoscopic instruments. By taking advantage of the da Vinci robot, surgeons are able to dissect and reconstruct the bladder with relative ease.

Benefits of robotic-assisted cystectomy

  • Minimal damage to vital muscle and delicate nerve tissue as a result of the surgery

  • A shorter hospital stay and an even faster return to a normal level of activity

  • Fewer noticeable scars

  • Minimized risk of blood loss

  • Minimized chances of post-operative infections

  • Minimized chances of post-operative incontinence or impotence

  • Minimized chances of other complications commonly associated with cystectomy

  • Minimal post-operative pain and discomfort

  • The unprecedented technology of the da Vinci Surgical System which offer surgeons, oncologists and urologists a high-definition, three-dimensional view of the procedure, as well as the assistance of the robot in suturing

Procedure summary

  • Designed to spare delicate nerve and muscle tissue

  • Keyhole-sized incisions distributed across the abdomen

  • A brief 4-to-7-day hospital stay

  • Less risk of blood loss and a lower chance of needing a blood transfusion

  • Reduced scarring, minimal discomfort, and less need for major pain medication

Only one to three month's period of recovery before regaining a normal level of urine control.

Cancers of the bladder are usually diagnosed by examining urine for cancer cells under a microscope (known as urine cytology) or during cystoscopy, an inspection of the bladder by inserting a slender tube equipped with a lens and a light through the urethra up to the bladder.

Recovery after robotic cystectomy treatment

  • You should continue walking when you return home, gradually increasing the distance. The walking will help you build strength.

  • Take planned rest periods during the day. The best gauge is your own body and how you feel.

  • You may walk up and down stairs as soon as you return home, but take them slowly. Plan activities so you need only go up and down several times a day. You will gradually build up to your pre-op routine as you regain your strength.

  • Avoid heavy lifting (greater than 5 pounds) or strenuous activity for several weeks after you are discharged. Heavy lifting can increase abdominal pressure, which can put a strain on your incision and could create a small hernia. If you need to brace yourself to pick something up, it is too heavy.

  • Avoid bending. This is tiring and also increases abdominal pressure. If you must pick something up, bend at your knees (not at your waist) and stoop to pick up the object.

  • Avoid driving for four weeks or as directed by your physician. Take car breaks every several hours for extended trips. Get out of the car and walk around a bit.

  • Do not drive any motorized vehicle or sign any legal documents while taking narcotic pain medications. The narcotic medication may cause alteration in visual perception and impair judgment.

  • Gently wash your incision with soap and water. Rinse and pat dry. You may take a shower. Do not take a tub bath until the incision has healed completely.

  • If you have white strips called “steri-strips” on your incision, they should fall off in about seven days. If they do not fall off, you may remove them.

  • Once your incision has healed completely, you may take a tub bath with your pouch on or off.

  • Try to choose a time when the stoma is less active if you choose to bathe with the pouch off.

  • Wait a few hours for adhesive to dry after putting on a new pouch before getting into the water.

  • Return to normal eating habits, although small frequent meals are better tolerated at first.

  • You may notice that garlic, onions, spices or asparagus may cause an odor of your urine. If you notice an increase in odor, simply limit these foods in your diet if you choose.

  • Drink fluids on a regular basis to assist in flushing mucous from the urine. The mucous is produced by the piece of bowel that was used to make the ileal loop. Drinking fluids will keep the mucous thin and prevent plugging of the stoma.

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