Robotic Surgery Used to Treat Bladder Cancer
MADISON - Just how far can a surgical robot go?
Surgeons at University of Wisconsin Hospital and Clinics are now removing cancerous bladders through an opening smaller than the width of a paper clip -- and through the same opening, replacing them with a substitute bladder created from the patient's own tissues.
Jason Gee, MD, a urologic cancer surgeon with the department of urology and University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, leads the hospital's robotic cystectomy program. He's one of several UW physicians using the Da Vinci surgical robot to remove cancerous bladders.
"The robot offers several advantages for the patient, including a dramatic reduction in blood loss and a smaller incision," explains Gee. "Not only can we remove the bladder through small incisions only a centimeter in length, but we can also construct a new bladder through a more cosmetic and less painful lower-abdominal incision."
A neobladder is a substitute bladder surgically constructed from a segment of the patient's intestine. It functions much as a normal bladder does.
Bladder cancer is the tenth most common cancer among men and the eighth among women. According to the National Cancer Institute, more than 80,000 Americans have been diagnosed with it in 2008 alone, and nearly 15,000 of those patients have died. Surgical removal of the bladder with urinary-tract reconstruction surgery remains a mainstay of treatment for muscle-invasive disease confined to the bladder.
Typically, surgeons have removed a cancerous bladder through a large midline abdominal incision, a procedure that can result in significant pain to the patient and requires several weeks of recovery. In men, the prostate gland is also typically removed.
The robot changes the procedure significantly.
As in all robotic surgeries, the surgeon controls the robot's arms from a nearby console, manipulating the surgical camera and instruments. Powerful magnification allows the surgeon to see the surgical field in far more detail. The procedure takes five to six hours to complete.
"The robot is effective because it allows for better patient outcomes, in terms of blood loss and postoperative pain," says Gee. "In addition, this technology can extend a surgeon's abilities with better visualization for a nerve-sparing dissection that can preserve a patient's potency."
For some patients, impotence is a side effect of standard cystectomy.
According to Dr. Gee, 60 percent of patients who undergo robotic cystectomy are eligible to use a constructed neobladder. The remainder can opt for another surgical approach.
Robotic cystectomy is an option for patients who have not had extensive abdominal surgery, radiation treatment or other significant medical issues that might increase their risks with the procedure. In addition to Dr. Gee, David Jarrard, MD, Reginald Bruskewitz, MD, and Sean Hedican, MD, are part of the UW team using the surgical robot.
Surgeons at UW Hospital and Clinics have been using the Da Vinci surgical robot since 2006 for a wide variety of procedures, including complex heart surgeries, radical prostatectomies, hysterectomies and gland-removal procedures.
Learn more about robotic surgery at UW Hospital and Clinics.
Date Published: 05/04/2009