Advanced Robotic Radical Cystectomy with Ileal Conduit at Fortis Hospital Bangalore

Robotic radical Cystectomy

Robotic radical Cystectomy is a robot-assisted minimally invasive surgical approach for treating muscle-invasive bladder cancer. It involves the removal of the entire bladder along with the regional lymph nodes. Since the entire bladder is removed, an alternative form of urinary diversion (new means for expelling urine from the body) is constructed as a part of the procedure by creating an Ileal Conduit.

Why is it performed?

Robotic radical Cystectomy is generally performed to treat Muscle invasive bladder cancer (MIBC). MIBC is an advanced stage of bladder cancer in which the cancer cells grow and spread beyond the inner lining of the bladder and move into the muscle layer. If left untreated, this cancer can spread to other areas of the body like the bones, the lungs, the liver, etc. and pose potential threats. Robotic radical Cystectomy can also be performed to treat transitional cell cancer. It is a type of cancer that develops in the renal pelvis and ureter. In certain cases, this cancer metastasizes and spreads to the bladder and other parts of the body.

How is it performed?

During a robotic radical cystectomy, a few small incisions are made in the abdomen by the surgeon. Small instruments and tiny camera which provides 3D images of the organs are inserted through the openings to reach the bladder. With the help of the robotic arms, the bladder is disconnected and removed by the surgeon. Occasionally, the nearby organs can also be removed along with the bladder to provide cancer control. In men, this kind of removal involves organs like prostate, part of the vas deferens and seminal vesicles. In women, the removal involves fallopian tubes, cervix, ovaries, uterus, and part of the vagina. A dissection of pelvic lymph node can also be carried out as a part of this surgery for the purpose of both staging and treating cancer.

Creation of an Ileal Conduit:

As the entire bladder is removed through robotic radical cystectomy, the body needs another means to collect and drive out the urine from the system. To achieve this, a urinary reconstruction is performed by creating an ileal conduit as a part of the procedure. During the creation of an Ileal conduit, the surgeon uses a portion of the small intestine called the ileum and creates a channel that connects the ureters to a surgically constructed opening in the abdomen called stoma. Now the urine from the kidney passes through the ureters and the newly constructed ileal conduit, enters the stoma and empties into an external collecting pouch. As the entire procedure is robot-assisted, the patient experiences less post-surgical pain and quick recovery.

What are its advantages?

Besides less scarring, shortened hospital stay and quick recovery, the Robotic Radical Cystectomy with Ileal Conduit has two unique advantages.

• The da Vinci Si surgical robot facilitates delicate dissection and paves the way for minimal blood loss. This eliminates the need for blood transfusions.
• Since the procedure involves the creation of an ileal conduit, it stamps out the need for occasional catheterization.