A cystectomy is the partial or total (radical) removal of the bladder. This can be done in multiple ways. Traditionally, a patient is given general anesthesia, an incision is made in the abdomen, large enough for a surgeon to put their hands in, and the surgeon removes the bladder manually.1 Newer methods include laparoscopic surgery, where a surgeon makes a series of small incisions around the patient’s abdomen and places small surgical instruments and cameras to help guide the bladder removal through these incisions. There are no surgeon’s hands inside the incisions in a laparoscopic surgery.1
The newest form of surgery
The newest form of surgery is a robot-assisted laparoscopic cystectomy (or robotic cystectomy). Like the traditional, open cystectomy surgeries a patient is given general anesthesia, and like regular laparoscopic surgeries, a series of small incisions are made and cameras and small instruments are placed in these incisions. The difference is that the instruments are held by robotic arms that are guided by a surgeon. These robotic arms allow the surgeon to do delicate surgical tasks with extreme precision.1 This surgery is done completely by a surgeon, and not by the robot; the robot is just a tool in the surgery process.
The benefits of robotic cystectomy
Robotic cystectomies are less invasive, and as a result have less scarring than traditional, open cystectomies. Patients who have robotic cystectomies tend to experience less post-operative pain and require less narcotic pain medications.2 These patients also have less blood loss, shorter hospital stays, and shorter time until their first post-operative bowel movement (which is a sign of healing post-surgery).2 After surgery, these patients tend to have shorter follow-up times.3
Robotic cystectomy allows surgeons better access to lymph nodes around the bladder and may give them a better ability to remove nodes affected by bladder cancer.2 Both Memorial Sloan-Kettering Cancer Center and the University of North Carolina have noted that patients who had robotic cystectomies had longer progression-free survival rates than patients who had traditional, open cystectomies, increasing as much as thirty percent.3 It should be noted that since robot assisted cystectomies are fairly new, there is not a lot of information about long-term survival rates.3
The cost of robotic cystectomy
It is also important to note that robotic cystectomies are more expensive than traditional cystectomies.4 This is in part due to the cost of using the robotic surgery machine, but it also due to the fact that robotic cystectomies take longer to perform than traditional cystectomies do. This leads to more cost in staffing, use of disposable equipment, and other variable surgery costs. While total surgery costs are higher with robotic cystectomies, hospital costs are more expensive with traditional, open cystectomies, due to longer hospital stays, and the need for more transfusions.
Not everyone is eligible for a robotic cystectomy. There are many reasons why a surgeon may have to perform traditional, open cystectomies. This is a discussion to have with your surgery and oncology teams. There are obvious pros and cons to both surgeries, and you and your surgery team have to decide which form of surgery is the best for you. It is important to do your research and make sure to go into your appointment with an open mind. Your team will work with you to make sure you have the best option for your individual case.
Robot assisted laparoscopic radical cystectomy and ileal conduit: a patient’s guide. University of Rochester Medical Center. Available online. Accessed 4/16/18.
Nix J, et al. Prospective Randomized Controlled Trial of Robotic versus Open Radical Cystectomy for Bladder Cancer: Perioperative and Pathologic Results
European Urology. 2010 Feb;57(2):196-201. doi: 10.1016/j.eururo.2009.10.024. Epub 2009 Oct 20.
Steinberg PL, Ghavamian R. Robotic-assisted radical cystectomy. Expert Rev Anticancer Ther. 2012;12(7):913-917. Available online. Accessed 4/16/18.
Smith A, et al. Cost Analysis of Robotic Versus Open Radical Cystectomy for Bladder Cancer. J Urol. 2010 Feb;183(2):505-9. doi: 10.1016/j.juro.2009.09.081. Epub 2009 Dec 14.