Robotic cystectomy

Robotic cystectomy is a minimally invasive surgical procedure to remove the bladder. It’s most often used to treat bladder cancer. During the procedure, a surgeon makes several small incisions and uses robotic technology to remove the bladder and surrounding tissues that may be cancerous through several small incisions, then creates a new pathway for urine to leave the body.

Penn Medicine has been a leader in robotic urologic surgery for more than a decade. Our fellowship-trained urologic surgeons were early adopters of robotic cystectomy and have extensive experience performing complex bladder cancer procedures and urinary reconstruction. Our integrated bladder cancer program offers coordinated care from experts in urologic oncology, medical oncology, radiation oncology, pathology, and supportive services, allowing for highly personalized treatment planning and comprehensive care throughout every stage of treatment.

A radical cystectomy procedure typically includes removal of the bladder as well as nearby lymph nodes, and, when necessary, adjacent organs that may be affected by cancer. In men, this may include the prostate and seminal vesicles. In women, it may include the uterus, ovaries, cervix, or part of the vaginal wall.

During robotic cystectomy, your surgeon operates from a specialized console that controls robotic instruments and a high-definition camera. The robotic system allows your surgeon to precisely move tiny surgical instruments inside the body.

After the bladder and any additional tissues are removed, the surgeon creates a new pathway for urine to leave the body in a procedure called a urostomy.

Compared with traditional open surgery, robotic cystectomy offers similar cancer-control outcomes while reducing the size of surgical incisions. The approach is associated with less blood loss, lower transfusion rates, shorter hospital stays, and a lower risk of certain wound-related complications.

Robotic cystectomy may be recommended for people with:

• Muscle-invasive bladder cancer (MIBC)
• High-risk non-muscle-invasive bladder cancer that has not responded to other treatments, such as intravesical therapy
• Recurrent or aggressive bladder cancers for which bladder removal offers the best chance for disease control

In deciding whether you are a candidate for robotic surgery, your care team considers the extent of the disease, prior abdominal or pelvic surgeries, overall health, and your ability to safely undergo a major operation. For most people who are candidates for cystectomy, robotic surgery can provide the same cancer-removal effectiveness as open surgery while offering the benefits of a minimally invasive approach.

Before surgery, you will undergo a thorough evaluation that may include imaging studies, laboratory testing, and discussions with members of your cancer care team. Some people receive chemotherapy before surgery as part of their treatment plan.

The procedure is performed under general anesthesia and typically takes several hours. During surgery, your surgeon removes the bladder and performs the urostomy. You may spend several days in the hospital after surgery, where the care team manages pain, monitors recovery, and encourages walking and activity.

Because robotic surgery uses smaller incisions, many people experience less postoperative pain and a quicker return to daily activities than with traditional open surgery. Recovery time varies depending on the extent of surgery performed, but most people can expect to gradually resume normal activities within a few weeks. Your Penn Medicine care team will provide detailed guidance on activity restrictions, wound care, nutrition, and adjustment to urostomy as you recover.