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Robotic Expansion: New Surgical Option Aids Bladder Cancer Patients

UW Health Services
 

MADISON - Bladder cancer is the latest medical condition to benefit from the advent and expansion of surgical robotics at UW Hospital and Clinics.

Dr. Jason Gee, a urologic surgeon with the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, is one of several UW physicians now using the Da Vinci surgical robot to perform robotic cystectomies – the surgical removal of cancerous bladders.

"The robot offers several advantages for the patient, but the biggest is that not only can we remove the bladder through an incision that's only about a centimeter in length, but we can also construct a new neobladder through that same port," explains Gee.

A neobladder is a substitute bladder surgically constructed from a piece of the patient's intestine that functions much the same way as a normal bladder.

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.

 

Some can be treated with radiation and chemotherapy treatments but in others, the cancer has advanced through the bladder, necessitating surgery. Typically, surgeons have removed a cancerous bladder by cutting a large incision in the abdomen, a procedure that causes 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 really extends your abilities as a surgeon," says Gee. "In addition to a faster recovery for the patient, there's also much less blood loss. The surgeon also gets much better visualization to help spare nerves."

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 an Indiana pouch, a bladder constructed of bowel tissue that eliminates urine through a catheter opening in the patient's abdomen, or an ileal loop, a treatment that requires the use of an exterior bag to collect urine.

Robotic cystectomy is an option for patients who have had no prior abdominal surgery or abdominal radiation treatment and aren't considered morbidly obese. In addition to Dr. Gee, Dr. David Jarrard, Dr. Reginald Bruskewitz and Dr. Sean Hedican are using the surgical robot to perform cystectomies at least one day each week.

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, prostatectomies, hysterectomies and gland removal procedures.