Care of the Radical Cystectomy Patient With a Robotic Approach
Care of the Radical Cystectomy Patient With a Robotic Approach
Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer. Cystectomy can be through an open or robotic-assisted laparoscopic approach. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for select surgeons to perform nerve-sparing robotic-assisted laparoscopic radical cystoprostatectomy. Advantages of robotic surgery may be minimal blood loss, shorter hospital stay, quicker recovery, and possibly more precise and rapid removal of the bladder depending on the experience and expertise of the surgeon. Appropriate patient selection and thorough pre-operative evaluation, however, are key in maximizing positive surgical outcomes. The experience at the University of Virginia with robotic-assisted laparoscopic radical cystectomy will be discussed.
More than 63,210 Americans were expected to be diagnosed with bladder cancer in 2005 (American Cancer Society [ACS], 2004). While the majority of bladder cancers were termed superficial, which do not invade the bladder wall muscle, about one-third were invasive cancer. Superficial tumors respond well to local therapy but 30% to 70% can recur. Additionally, the risk of progression to invasive cancer during followup can be as high as 10% to 30% (Messing, 2002). In 2004, the ACS predicted that more than 13,000 Americans would die of bladder cancer. The expected prognosis for persons with advanced meta static bladder cancer is less than 1 year (Dreicer, 2001). Under standing the differences in bladder cancer treatment approaches is important as health care providers help patients in their decision-making process. Treatment for invasive bladder cancer includes many options: (a) surgery, (b) radiation, (c) radiation plus chemotherapy, and (d) chemotherapy. One approach, robotic-assisted laparoscopic cystectomy for invasive bladder cancer, is reviewed here.
Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer (Menon et al., 2003). These surgeries may also be performed for alternate reasons such as (a) neurogenic or hostile bladder which may threaten the function of kidneys; (b) congenital abnormalities including bladder extrophy, epispadias, or cloacal exstrophy; (c) radiation fibrosis or cystitis that may arise from exposure to external beam radiation; or (d) interstitial radiation for pelvic or gynecologic cancers. Several factors should be considered when choosing a treatment option: (a) patient age, (b) overall health, (c) the grade and stage of the cancer, (d) and an evaluation of the risks and benefits of each option (Netherlands Cancer Institute, 2006).
Cystectomy can be performed through an open or robotic-assisted laparoscopic approach. It is a complex operation associated with potential for significant complications and requires surgical expertise. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for a few surgeons to perform nerve-sparing robotic-assisted laparo scopic radical cystoprostatectomy (Menon et al., 2003). While a patient may be a candidate for robotic-assisted surgery, he may not be a candidate for each type of urinary diversion. This may influence the type of surgical approach. While the cystectomy is performed robotically, the diversion is still performed in a traditional open approach. Advances in robotic abilities to perform the diversions laparoscopically will likely be a future goal.
Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer. Cystectomy can be through an open or robotic-assisted laparoscopic approach. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for select surgeons to perform nerve-sparing robotic-assisted laparoscopic radical cystoprostatectomy. Advantages of robotic surgery may be minimal blood loss, shorter hospital stay, quicker recovery, and possibly more precise and rapid removal of the bladder depending on the experience and expertise of the surgeon. Appropriate patient selection and thorough pre-operative evaluation, however, are key in maximizing positive surgical outcomes. The experience at the University of Virginia with robotic-assisted laparoscopic radical cystectomy will be discussed.
More than 63,210 Americans were expected to be diagnosed with bladder cancer in 2005 (American Cancer Society [ACS], 2004). While the majority of bladder cancers were termed superficial, which do not invade the bladder wall muscle, about one-third were invasive cancer. Superficial tumors respond well to local therapy but 30% to 70% can recur. Additionally, the risk of progression to invasive cancer during followup can be as high as 10% to 30% (Messing, 2002). In 2004, the ACS predicted that more than 13,000 Americans would die of bladder cancer. The expected prognosis for persons with advanced meta static bladder cancer is less than 1 year (Dreicer, 2001). Under standing the differences in bladder cancer treatment approaches is important as health care providers help patients in their decision-making process. Treatment for invasive bladder cancer includes many options: (a) surgery, (b) radiation, (c) radiation plus chemotherapy, and (d) chemotherapy. One approach, robotic-assisted laparoscopic cystectomy for invasive bladder cancer, is reviewed here.
Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer (Menon et al., 2003). These surgeries may also be performed for alternate reasons such as (a) neurogenic or hostile bladder which may threaten the function of kidneys; (b) congenital abnormalities including bladder extrophy, epispadias, or cloacal exstrophy; (c) radiation fibrosis or cystitis that may arise from exposure to external beam radiation; or (d) interstitial radiation for pelvic or gynecologic cancers. Several factors should be considered when choosing a treatment option: (a) patient age, (b) overall health, (c) the grade and stage of the cancer, (d) and an evaluation of the risks and benefits of each option (Netherlands Cancer Institute, 2006).
Cystectomy can be performed through an open or robotic-assisted laparoscopic approach. It is a complex operation associated with potential for significant complications and requires surgical expertise. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for a few surgeons to perform nerve-sparing robotic-assisted laparo scopic radical cystoprostatectomy (Menon et al., 2003). While a patient may be a candidate for robotic-assisted surgery, he may not be a candidate for each type of urinary diversion. This may influence the type of surgical approach. While the cystectomy is performed robotically, the diversion is still performed in a traditional open approach. Advances in robotic abilities to perform the diversions laparoscopically will likely be a future goal.
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