When the tumor invades the bladder muscle, it is necessary to completely remove the bladder and rebuild the urinary tract using different techniques.
Robotic radical cystectomy
It consists of removing the bladder (and the prostate in the case of men, in the case of women it includes the uterus and two-thirds of the anterior face of the vagina). A lymphadenectomy is also performed, which involves removing lymph nodes. In this way, it is possible to remove all tumor tissue.
Once the bladder has been removed, the reconstruction of the urinary tract is required. Depending on the case, this reconstruction may be by interposing a bowel loop that approaches the skin (ileal duct, Bricker technique) or by making a Neo-bladder, in which case urinary continence is preserved and will not be It is necessary for the patient to wear urine elimination bags.
Robotic surgery provides the possibility of avoiding the surgical incision and therefore the consequences of contact of the intestinal loops with the exterior, so that recovery is much swifter.
Usually, hospital admission lasts 10-14 days and intensive care is required for the first 24-48 hours.
Brief description of the procedure
The patient is placed in a supine position under general anesthesia. 4 holes are made in the lower abdomen, these small holes are what the robot uses as access ports to introduce the instruments.
The bladder and pertinent structures are removed according to the sex of the patient, followed by lymphadectomy. Next, the urinary reconstruction is carried out either with the ileal conduit or the making of a neobladder, in both cases it will be necessary to manipulate the small intestine.
At the end of the surgery, the excised tissue is removed through one of these slightly enlarged mini-incisions and a drain is placed. The duration of the surgery is between 4-8h (varying depending on the urinary diversion to be performed and the difficulties that may arise). Admission lasts between 7-10 days, the first 48 hours in the ICU. It takes between 3 and 5 weeks of convalescence before you can gradually begin to recover your usual activities.