Let's learn about Robotic Cystectomy?

When your doctor tells you or someone in your family has bladder cancer, you may feel a great sense of fear and shock. And when you are told that you will have to have surgery to remove the entire bladder, that fear may be doubled. That is very normal. But don't be afraid. With the advancements in medicine today, there are ways to perform even major surgeries like this much safer, with less pain, and with a quicker recovery than before. Today, we will talk about a very advanced technology used in such cases, called a "Robotic Cystectomy."

Simply put, what is Robotic Cystectomy?

This is also a surgery to remove the bladder. But it is not done through a large incision in the abdomen like before. This is a very minimally invasive procedure. Simply put, the surgeon makes a few very small holes in your abdomen and inserts a robotic arm and camera into your body through them. The doctor then looks at a computer screen and controls the robotic arm with a special console to perform the surgery with great precision.

This surgery is performed in two main ways:

• Robotic Partial Cystectomy: In this, only the part of the bladder containing the cancer is removed.
• Robotic Radical Cystectomy: This involves removing the entire bladder. This surgery is often performed for bladder cancer.

The doctor will explain to you which surgery is best for you based on your condition.

In what cases is this surgery performed?

The main reason for this surgery is often bladder cancer . However, it is also sometimes recommended to treat congenital urinary anomalies.

What is removed during surgery?

First, your bladder and surrounding lymph nodes are removed. In addition, depending on how far the cancer has spread, some of the surrounding organs related to the reproductive system in both men and women may also need to be removed. This is done to completely remove the cancer and reduce the risk of it coming back.

How do you prepare before surgery?

Before the surgery, you will meet with the doctor. He will explain all the details about the surgery to you, obtain your consent, and perform a physical examination to see if you are healthy enough to undergo the surgery.

You should remember to tell the doctor these things:

• All the medications you take. That means those prescribed by doctors, over-the-counter (OTC) medications, traditional Sinhala medicines, vitamins, Ayurvedic medicines, everything. Because blood thinners like aspirin can increase bleeding during surgery.
• Be sure to tell us about any allergies you have. Allergies to certain medications, skin cleansers (iodine), latex, and certain foods.

The doctor will give you clear instructions about when to stop eating and drinking before surgery, and whether or not to stop taking medications.

Is robotic surgery really performed by a robot?

No. This is where many people misunderstand. This surgery is not performed by a robot.

In this case, a highly trained surgeon (Urologist) is in complete control of the surgery. The robot is just a very advanced, delicate tool that the doctor uses. Think of it like a skilled artist using a very delicate brush to paint a beautiful picture. The robot provides the doctor with these benefits:

• The surgical area can be clearly viewed in 3D , high-definition, and enlarged.
• It can perform movements that are so delicate, precise, and unwavering that a human hand cannot.

Therefore, the doctor himself performs the surgery, and the robot just acts as an extension of his hands.

How the surgery is performed and new methods of making urine flow

After your bladder is completely removed, you will need to create a new way for urine to exit your body. This is called a ``Urinary Diversion''. The doctor will use a part of your own intestine to create this new path. There are three main methods.

1. Ileal Conduit:

• What's different: A piece of your own small intestine is taken and made into a tube. The ureters from the kidneys are connected to it. The other end is made to come out through the skin of the abdomen. This is called a ``(Stoma)``.
• Urine collects: An ostomy bag is attached to the outside of this stoma to collect urine. This bag must be emptied regularly.

2. Continent Cutaneous Diversion:

• What's different: Here, too, parts of the intestine are used to create a small bag (reservoir) that collects urine from inside the body. It is also connected to the skin of the abdomen through a `stoma`.
• Urine collects: But you don't need an external bag. You can empty the bag inside by inserting a small tube (catheter) several times a day.

3. Neobladder Reconstruction:

• What's different: In this procedure, a long piece of intestine is also taken and a new bladder-like structure called a ``Neobladder'' is created from it. It is connected directly to your urethra.
• Urinating: This means you will be able to urinate normally, just like you did before surgery. However, at first, you will need to practice things like tightening your abdominal muscles to urinate.

Your doctor will help you choose the method that best suits you from these three methods.

What are the advantages of robotic surgery?

Robotic surgery has several advantages over traditional open surgery.

Are there any risks to this surgery?

Like any major surgery, there are some risks involved, but advanced technology can minimize these risks.

• General risks: bleeding, blood clots, infection, reactions to anesthesia (vomiting, headache).
• Specific risks:
• Changes in urination: The way you urinate will change after surgery. It takes time to get used to it.
• Sexual side effects:
• For men: If the prostate gland and seminal vesicles are removed, ejaculation will not occur. Some men may experience erectile dysfunction.
• For women: If part of the vagina is removed, sexual intercourse may be difficult. The nerves involved in sexual arousal and ejaculation may also be affected.

How long does it take to heal and when should I see a doctor?

It can take weeks to months to fully recover. This is a major surgery, so give your body time to recover. It is normal to experience loss of appetite and changes in bowel habits (diarrhea, constipation) after surgery.

However, if you experience any of the following symptoms, call your doctor immediately or go to the hospital's Emergency Treatment Unit (ETU).

• Signs of infection, such as fever, chills, and shivering .
• Vomiting that cannot be stopped.
• Heavy bleeding from surgical sites.
• If there is increasing pain, swelling, or discoloration (red, brown, black) around the incision.
• The pain is so severe that the medicine given by the doctor cannot control it .
• If it is difficult to urinate or if the urine flow is reduced through the new opening.