Bladder cancer treatment can come with some tough decisions, especially when you find yourself facing a major surgery. Robotic cystectomy is a relatively new type of procedure for bladder cancer care. Compared to open surgery, robotic surgery offers a less invasive option and faster recovery times. But what should you expect from an operation like a robot-assisted cystectomy? Here’s a closer look at how it works, the recovery process, and the risks and benefits of this procedure for people with bladder cancer.

Surgical Management of Bladder Cancer

Bladder cancer treatment varies depending on the stage and type of bladder cancer. A cystectomy — surgical removal of your bladder — may be a part of the treatment plan for people with bladder cancer.

Your care team may choose to perform a partial or radical cystectomy. A partial cystectomy is less common and is done when cancer only affects part of the bladder. In more advanced cases of bladder cancer, you may have to undergo a radical cystectomy — surgical removal of the entire bladder, nearby organs, and lymph nodes. This is especially true for muscle-invasive bladder cancer.

A robotic cystectomy may be used to remove part of the bladder (a partial cystectomy) or the entire bladder (a radical cystectomy).

There are two main approaches to a cystectomy in bladder cancer treatment:

• Open cystectomy — Open surgery that uses a large incision (cut) in the abdomen (lower belly) to remove part of or the entire bladder
• Minimally invasive cystectomy — Laparoscopic and robotic surgery that uses smaller incisions and cameras to remove part of or the entire bladder

Urologists are surgeons trained in the diagnosis and surgical treatment of diseases and conditions of the urinary system and reproductive organs. They will work closely with the rest of your care team to determine the best procedure for you.

What Is a Robotic Cystectomy?

A robotic cystectomy is a minimally invasive procedure to remove either part of the bladder or the entire bladder. In this procedure, your surgeon will use robotic arms to remove all or part of your bladder. Depending on whether your bladder cancer has spread, your care team may also remove some nearby tissue from areas like the lymph nodes or reproductive organs. If your cancer has spread extensively, your care team may choose to perform a traditional open surgery instead of a robotic cystectomy.

In most cases, people fully recover in six to eight weeks after robotic cystectomy.

How Is a Robotic Cystectomy Performed?

Your surgery will begin with anesthesia given by an anesthesiologist, who will make sure you remain comfortable and pain-free during the surgery. Once you are asleep, the surgeon will make small incisions in your abdomen. These are used to insert ports for robotic arms and a camera. The surgeon then uses these tools to remove the bladder and other structures.

Urinary Diversion

In cases where the entire bladder is removed, your care team will have to create a new way for urine to be released from the body. This is called a urinary diversion. There are three common types of urinary diversions created during robotic cystectomies.

Ileal Conduit

An ileal conduit is when your surgical team uses a piece of your small intestine (called the ileum) to create a urinary diversion. In this procedure, your care team connects your ureters (the tubes that carry urine from the kidneys to the bladder) to one end of the ileum. Then they create a stoma (an opening in the abdomen) and connect it to the other end of the ileum. From this procedure, urine will be diverted into an external bag (ostomy bag).

Continent Cutaneous Diversion

A continent cutaneous diversion (CCD) is when your surgical team uses small pieces of the small and large intestine to make an internal pouch, called an ostomy pouch. Your care team will then connect the ureters to the pouch. Urine will be collected in the pouch, and you will have to drain it with a catheter (tube) from time to time without wearing an external ostomy bag.

Neobladder

Your surgical team may use part of your small intestine to make a substitute bladder known as a neobladder. Your existing urinary tract structures (ureters and urethra — tube that drains the bladder) are then connected to the neobladder.

The ileal conduit and CCD are both types of urostomy. This is when your surgical team makes a stoma through which urine can be removed without a bladder. On the other hand, a neobladder is an internal structure that allows you to pass urine similarly to how you would normally.

Additional Procedures Performed During a Cystectomy

In advanced bladder cancer cases that require a radical cystectomy, surgeons may perform additional procedures like removing other organs. Depending on your body and your individual case, these may include:

• The prostate
• The seminal vesicles (reproductive organs that make semen)
• The urethra (the tube that carries urine out of the body)
• The lymph nodes in the region
• The uterus, ovaries, and fallopian tubes (reproductive organs)

What Is Recovery After Robotic Cystectomy Like?

Recovering from a robotic cystectomy takes time, patience, and support. While the surgery is less invasive than traditional open surgery, it’s still a major surgery. Here’s what you can expect during your recovery journey.

Postoperative Recovery in the Hospital

In most cases, you will spend around four days to two weeks in the hospital after a robotic cystectomy. Key aspects of hospital recovery include:

• Helping you control pain
• Teaching you how to manage urinary diversion
• Watching for surgical complications

During your hospital stay, your care team will monitor for complications like:

• Bleeding
• Infection
• Blood clots
• Urinary diversion issues (like blockages, ostomy pouch leakage, or stoma issues)
• Bowel (or intestine) problems

At-Home Recovery

After you’ve left the hospital, there will still be time and work needed for recovery. Recovery times vary depending on whether you have had a partial or radical cystectomy. The time can also vary based on your general health and other complications. In most cases, people fully recover in six to eight weeks after robotic cystectomy.

During the recovery time, you will be encouraged to:

• Slowly increase your physical activity
• Maintain a healthy diet (your care team should give you guidance about what this means for you)
• Care for your incision sites or stoma
• Go to follow-up appointments with your care team

There are some side effects from the surgery that you may notice. These include:

• Fatigue (extreme tiredness)
• Pain or discomfort
• Swelling or bruising
• Digestive issues
• Odors in urine
• Changes in bowel movements

Other side effects if you also had reproductive organs removed include:

• Hot flashes and vaginal dryness
• Changes in sexual function
• Infertility

What Are the Benefits of Robotic Cystectomy?

Robotic cystectomy offers several advantages over a traditional open radical cystectomy. At the same time, the results of robotic surgery have outcomes similar to those of open surgery. This procedure is preferred for those who are eligible for a less invasive approach, to limit recovery time and postoperative discomfort.

Benefits of robotic cystectomy include:

• Smaller incisions
• Less blood loss
• Decreased surgical complication rates
• Less pain after the operation
• Shorter hospital stays
• Lower risk for infection after the operation
• Less noticeable scars

What Is Life After Robotic Cystectomy Like?

Having a robotic cystectomy can be an important step in treating your bladder cancer. After a cystectomy, it’s still possible to maintain a high quality of life. While the journey may require physical and emotional adjustments, the right support can help you maintain a proactive and positive approach to recovery.

Adjusting to Urinary Diversion

A key part of adjusting to life after cystectomy involves adapting to a urinary diversion. Depending on whether you have a neobladder, an ileal conduit, or other urostomy, you will have different ways to manage urine removal. Each type of diversion has benefits and challenges.

Ileal Conduit

With an ileal conduit, you’ll have an external ostomy bag. You’ll need to learn how to attach, empty, and change your ostomy bag. It’ll take time to adjust to maintain the ostomy system and understand how to schedule time for care. With time, managing the ostomy system will be a routine part of your day.

Continent Cutaneous Diversion

With a CCD, you’ll have an internal ostomy pouch. You’ll have to pass a catheter through the stoma regularly to empty the ostomy pouch. Some people may prefer this option over having an external bag. Just like an ileal conduit, it will take time to adjust and to develop a routine.

Neobladder

With a neobladder, it’ll take time and practice to train your muscles and gain full control of the neobladder. At first, the neobladder won’t have the same reflexes as your original bladder. For a while, you may have to empty it every two to three hours.

It’s important to be patient with yourself and know that sometimes you may have nighttime leakage. You may also notice a pale mucus for a while after surgery. This is due to the nature of using part of the intestines to create the neobladder. The amount of mucus will decrease over time, but it won’t go away completely. Many people regain control and find that a neobladder helps improve their quality of life.

Your Care Team Is There To Help

Your care team will help guide you through the process of caring for your urinary diversion. They’re a great resource to teach you how to care for and use an ostomy pouch, an ostomy bag, and other devices needed for a urinary diversion. They can answer your questions and concerns and provide additional resources. Adjusting to a urinary diversion can seem daunting, but with time, support, and the right resources, you will be able to resume your normal activities.

Connect With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you undergone a robotic cystectomy, or are you considering one? What has your recovery experience been like? Share your experience in the comments below, or start a conversation by posting on your Activities page.