About bladder cancer surgery at MedStar Health
Men and women with bladder cancer may need surgery to remove all of the bladder or a portion of it. Called a cystectomy, our experienced urologic surgeons most commonly perform surgery to remove bladder cancer and create urinary diversions using minimally invasive robotic techniques and tiny incisions. Patients who undergo a robotic-assisted cystectomy (or robotic cystectomy) benefit from shorter hospital stays, less pain, and quicker recoveries.
Our urologic oncologists are experts in performing bladder removal surgery using minimally invasive approaches that help patients return to their lives faster with fewer risks of complications. Patients choose us for bladder cancer surgery because:
- We’re pioneers in robotic surgery. Our bladder cancer surgeons have extensive experience using robotic technology to mimic open surgery using smaller incisions and exceptional precision. This results in less blood loss and damage to healthy nerves and tissue, translating to shorter recoveries. We continue improving outcomes for patients with bladder cancer surgery through our leadership and participation in research and clinical trials.
- We perform a high number of bladder cancer surgeries every year. Our urologic surgeons treat a high number of patients with bladder cancer every year, giving us the experience and skills necessary to treat even the most complex cases. When patients aren’t candidates for robotic surgery, we are one of few programs in the region who also has expertise in traditional, open surgery.
- We offer personalized, comprehensive cancer care. As part of the Georgetown Lombardi Comprehensive Cancer Center, we work as a multidisciplinary team to design a customized treatment plan designed to meet all of your needs in one place.
What is a radical cystectomy?
Also called a total cystectomy, a radical cystectomy is surgery to treat bladder cancer by removing the entire bladder and any surrounding tissue and lymph nodes impacted by cancer. After completely removing the bladder, your surgeon also needs to construct a urinary diversion, or a new way to store and remove urine from the body in the absence of the bladder.
What is a robotic-assisted radical cystectomy?
During an open radical cystectomy, a surgeon operates through one long incision in the abdomen. In contrast, a robotic-assisted radical cystectomy allows your surgeon to remove the bladder (and reconstruct the urinary tract) through tiny incisions and with the help of a sophisticated robotic system that enhances their visualization and dexterity during surgery. To perform a robotic cystectomy, your urologic oncologist will:
- Create very small incisions the size of a keyhole in the abdomen
- Visualize the operating site from a surgeon’s console through a high-definition 3D camera placed in the incisions
- Use a robotic arm and dime-sized instruments to perform the surgery with exceptional precision than the human hand alone
Creating a urinary diversion after a radical cystectomy
The bladder is completely removed during a radical cystectomy. Therefore, your surgeon will need to reconstruct the urinary tract so your body can store and get rid of urine. Your urologic surgeon can create a urinary diversion using one of the following:
- Ileal conduit: Most commonly, your surgeon will detach a portion of the small intestine, called the ilium. One end of the ileum will be connected to the ureters and the other end will be connected to an opening through the abdomen, called a stoma. This creates a new passageway for urine to flow out of the body. A small bag will be attached to the stoma to collect urine. The bag will need to be emptied when it gets full. Our dedicated ostomy nurses help you learn how to care for your stoma and change your urine collection bag.
- Continent cutaneous pouch (CCP): If your surgeon uses a continent cutaneous diversion, they will take small pieces of your small and large intestine to form a pouch. One end of the pouch will be attached to the ureters so it can store urine as it drains. The continent cutaneous pouch will also connect to the stoma, or a small opening in the abdomen. To drain the pouch, you’ll insert a small catheter through the stoma.
- Neobladder: Your surgeon may reconstruct part of your small intestine to create a substitute for your bladder. The newly constructed pouch will be connected to the ureters and the urethra, allowing patients to push urine out of the body naturally. Therefore, you won’t need an external pouch to collect urine.
Benefits of robotic surgery to remove bladder cancer
Using the da Vinci Surgical System to perform bladder cancer surgery allows your MedStar Health surgeon to make smaller incisions and spare vital, but delicate, nerve and muscle tissue. As a result, robotic cystectomies offer numerous benefits for our patients, including:
- Less pain
- Shorter hospital stays
- Quicker return to daily life, work, and hobbies
- Fewer noticeable scars
- Less blood loss
- Less risk of complications
- Minimal chances of postoperative infections
Other types of bladder cancer surgery
Transurethral resection of a bladder tumor
The most common type of bladder cancer surgery is called a transurethral resection of a bladder tumor, or TURBT. During TURBT, a urologic oncologist accesses the bladder through a long, thin tube (cystoscope) placed into the urethra during a procedure called “cystoscopy”. Then, they can remove the small, non-invasive bladder tumor with a tool placed in the cystoscope.
Open surgery
In addition to minimally invasive bladder cancer surgery, our surgeons are highly experienced in performing traditional open cystectomies, which remains an important skill. This ensures patients who have certain comorbidities, such as COPD or heart failure, can safely undergo surgery to remove bladder cancer.
Robotic partial cystectomy
A partial cystectomy involves removing only the portion of the bladder where a small tumor is. This allows the patient to keep their natural bladder and avoid reconstructive surgery. Like a robotic radical cystectomy, a partial cystectomy can be performed using advanced robotic-assisted technology to operate with smaller incisions and high success rates. Few patients are eligible for a partial cystectomy because of the risk of cancer occurring elsewhere in the bladder.
Recovery after robotic bladder cancer surgery
If you have a partial or radical cystectomy, you can expect to stay in the hospital for four to seven days, on average. Because robotic surgery is less invasive than open surgery, you will have less risk of blood loss, reduced scarring, minimal discomfort, and less need for major pain medication.
After you return home, here’s what you can expect.
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Getting around after surgery
- You should continue walking when you return home, gradually increasing the distance.
- 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.
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What to avoid after surgery
- 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.
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Caring for your incision and/or stoma
- 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 the adhesive to dry after putting on a new pouch before getting into the water.
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Eating after a radical cystectomy
- 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 in your urine. If you notice an increase in odor, simply limit these foods in your diet if you choose.
- Drink fluids regularly 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.
Bladder cancer surgery research and clinical trials
We’re part of the Georgetown Lombardi Comprehensive Cancer Center, the only comprehensive cancer center designated by the National Cancer Institute in Washington, D.C. As a leader in cancer research, our urologic oncologists continue investigating new surgical techniques, offering more hope to patients with bladder cancer. As a patient at MedStar Health, you gain access to new therapies and surgeries in clinical trials that may not be widely available elsewhere.
Click the link below to view our current bladder cancer clinical trials, choosing “genito-urinary” under “oncology group.”
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