Laparoscopic Radical Cystectomy

Overview

Laparoscopic radical Cystectomy is done to treat bladder cancer. Since bladder cancer spreads quickly, the procedure helps to remove cancer from the bladder and the nearby lymph nodes, part of the urethra and the surrounding organs. In men, the seminal vesicles, the prostate and the part of the vas deferens are removed, while in women, the uterus, the ovaries, the fallopian tubes, the cervix and the vagina are removed.

The procedure can be performed as an open surgery, while it can be done with a laparoscopic technique, which is also called ‘’Band-Aid surgery’’ that requires only a few cuts. If you undergo a cystectomy, a new channel is created to help you pass urine.

During the procedure, the surgeons create a tube out of the patient’s small intestine and connect the ureters to a small opening in the skin of the belly. This helps your urine to pass from the ureters through the tube out in the opening into a plastic bag.

The purpose of laparoscopic radical cystectomy is to cure cancer that has invaded the walls of the bladder by preventing the recurrence and spread of cancer. There are certain things to think about before you undergo the surgery.

The surgery affects both male and female fertility. If a man’s prostate is removed, he won’t be able to become a father again. Similarly, a woman cannot become pregnant if her ovaries and uterus are removed. Apart from this, the surgery has greater negative impact on your sexual functions as well, which can, however, improve with time.

The risks and complications associated with laparoscopic radical Cystectomy involve bowel obstruction, leaking stool or urine, kidney infection, kidney problems, renal failure, obstruction in the intestines or ureters, scar tissues inside the intestines, any problems in the stoma, etc.

Before you have an operation, there are few preparations for laparoscopic radical Cystectomy.

Before the treatment

• You need to take appointments with your doctors so that you can tell him about your health conditions, whether there is any particular concern/concerns, the types of medicines you are taking, etc.
• Based upon your health condition and the procedure you will undergo, your doctor may suggest you stop taking certain medications like aspirins and blood thinners. He may prescribe newer medicines that you are supposed to take before the surgery.
• Talk to your anaesthesiologist about the about the type of anaesthetics you will given and whether it will have any effect on your condition during and after the surgery.
• Bowel preparations are done routinely to minimize risk of postoperative infections and complications. It is important to have your entire intestine cleaned before the surgery. For the same, you are given bowel cleaning medicines or laxatives to clear your bowel.

How it is performed

The operation takes 4-8 hours to complete.

• After the patient is administered anaesthesia, the doctor creates six incisions in the abdomen to help insert laparoscopic ports through the cuts.
• Special instruments are inserted through the other cuts to remove the lymph nodes and the bladder. Another tube is inserted through one of the other cuts that have a camera fitted to its one end to help in viewing the inside of the patient’s body. The procedure is done with robotic-assisted laparoscopic technique. However, you should know that only selected patients are suitable candidates for the procedure.
• In men, the bladder and the surrounding lymph nodes are removed. Women, on the other hand, get their parts of the vagina, ovaries, fallopian tubes, cervix and uterus removed.
• During the operation, a portion of your intestine is used to create a tube for connecting it to the ureters through an opening in the skin into a pouch for urinary diversion.
• The best part is there is decreased blood loss, shorter hospital stays, earlier return of bowel function and earlier return to full activities associated with the surgery.

Recovery

The recovery of laparoscopic radical cystectomy takes some time, but you can speed up the recovery by following all post-operative instructions by your doctor. The hospital stay usually takes 6-8 days, after which you are discharged.

Immediately after the operation, you are transferred to the recovery unit where you will get an epidural that will help ease the pain. A tube is placed in your nose to help decompress the stomach. Gradually, you will be able to have small sips of water and soft foods as you begin to recover. You will not have any bowel movements for days after the surgery until the intestine recovers.

For quicker recovery, patients are asked to walk and stand between resting the whole day. Common side effects of laparoscopic radical Cystectomy are pain, constipation, nausea, but these can be treated with the right medications.

Even after the procedure, you need to visit the clinic for after-care appointments. In case of symptoms like fever, swelling in the leg, acute nausea and vomiting, swelling at the incisions, you should refer to your doctor right away.