This minimally-invasive procedure, performed with the da Vinci Surgical System, is used to treat bladder cancer by removing all or part of the bladder. In men, treatment may also require removal of the lymph nodes, prostate and seminal vesicles. In women, treatment may also require removal of the surrounding lymph nodes, cervix, uterus, fallopian tubes and ovaries.
After anesthesia is administered, the patient is positioned on an adjustable platform that allows the robotic surgical arms full access to the abdomen. The abdomen is cleaned, sterilized, and inflated with carbon dioxide gas. The gas creates working space for the surgeon's instruments.
Five to seven small incisions are created on the abdomen. The surgery will be performed through these tiny holes, rather than the large incision traditionally used for open surgery. An additional incision may be needed at the end of the surgery to remove the detached organs from the body. The da Vinci approach minimizes pain, scarring, risk of infection, and recovery time.
The surgeon attaches an endoscopic camera and various surgical instruments to the robotic arms and carefully inserts the instruments through the incisions. The surgeon then takes a seat at the console to perform the procedure. A video monitor in the console, which is linked to the endoscope, allows the surgeon to view the surgical site in 3D and precisely control the instruments during the surgery.
Various surgical instruments are attached to the robotic arms and inserted through the abdominal incisions. Clips are placed on the ureters, the tubes that connect the kidneys to the bladder. The ureters are cut and detached from the bladder.
The surgeon carefully separates the bladder from the pelvic wall and from other structures in the abdomen. The prostate, seminal vesicles and a portion of the urethra may also be cut away. The freed tissues are placed in specimen retrieval bags inserted through the incisions on the abdomen. These tissues may be removed through an incision.
The next part of the surgery may be performed through an open incision. A portion of the patient's intestine will be separated and used to create a new pathway for urine to drain from the kidneys. Options can include an ileal conduit, a pouch, or a neobladder. This animation shows construction of a neobladder.
A small incision is created on the abdomen. The specimen retrieval bags that hold the bladder, lymph nodes and other tissues are removed through this incision. A portion of the patient's intestine is separated and sewn to create a large pouch that will hold the urine. This pouch is called the neobladder.
The ureters are attached, allowing the urine to drain from the kidneys into the neobladder. The surgeon must then create a pathway for urine to exit the neobladder and flow out of the body. In some cases, the urethra can be attached to the base of the neobladder. The surgeon may install a temporary drain in the abdomen or in the neobladder during the healing process.
The instruments are removed, and the incisions are closed and bandaged. Most patients will go home after several days when they are comfortable managing their new bladder. Home nursing assistance and frequent doctor's visits may be needed for a short period of time.
Although a neobladder functions much like a real bladder, it will not create the same sensation of fullness and discomfort that a person normally feels when the bladder is full. Because of this, patients typically follow a strict regimen of emptying the neobladder every four to six hours. Some patients can learn to flex their pelvic muscles to empty the neobladder, others will require a catheter.