Open Surgery vs. Robotic Assisted Surgery for Bladder Cancer
- Surgery for bladder cancer often involves removing the bladder and surrounding tissue. Urinary diversion, or a procedure to reroute the normal flow of urine, may also be necessary.
- There are two common methods of surgery. Open surgery is surgery that requires a large incision, so the surgeon has direct access to the tumor and surrounding tissues. Robotic-assisted laparoscopic surgery is a type of minimally-invasive surgery in which your surgeon uses a robot to control surgical instruments through small openings in your body.
- Robotic cystectomy and open cystectomy are both good choices if you have been diagnosed with bladder cancer that has not spread.
Surgery often involves removing the bladder and surrounding tissue. Urinary diversion, or a procedure to reroute the normal flow of urine, may also be necessary.Read More
- Open surgery: surgery that requires a large incision, so the surgeon has direct access to the tumor and surrounding tissues.
- Robotic-assisted laparoscopic surgery: a type of minimally invasive surgery in which your surgeon uses a robot to control surgical instruments through small openings in your body.
Open Surgery for Bladder Cancer
“Open surgery refers to using a scalpel to make a cut on the skin starting at the belly button and going down, and then using our hands to do the operation to remove the bladder,” says Dr. Jay Shah, associate professor of urology at Stanford University and Cancer Care Program Leader for Urologic Oncology at the Stanford Cancer Center.
While open surgery is more invasive, it’s sometimes a better approach for people who need urinary reconstruction and diversion.
Advantages of Open Surgery:
- More surgeons are trained to perform open surgery
- Surgeon has immediate access to the entire bladder, in case of unexpected emergency
- More invasive than robotic surgery, which means a longer hospital stay and recovery time
- May have a higher risk of bleeding and infection
Robotic-Assisted Surgery for Bladder Cancer
“The main difference between open cystectomy and robotic cystectomy is that instead of making one big cut right down the middle from the belly button, for robotic surgery, the surgeon makes several small keyhole-size incisions, puts little instruments through there, and does the entire operation using a robot to control those instruments,” explains Dr. Shah.
Robotic cystectomy and open cystectomy are both good choices if you have been diagnosed with bladder cancer that has not spread. Because long-term outcomes are similar between the open and robotic approaches, procedure choice is often driven by patient preference and surgeon experience with particular techniques.
Advantages of robotic cystectomy:
- Less pain
- Less blood loss and lowered risk of infection
- Potential for shorter hospital stays and recovery time
- Minimal scarring
- Increased risk of urinary tract infections
- A longer learning curve; not all urologists are trained in robotic cystectomy
- May need to travel further to find a facility that specializes in this approach
“What you don’t want is to have a robotic surgery by someone who’s never done robotic surgery, or vice versa, open surgery by someone who’s only trained in robotic surgery,” adds Dr. Shah.
“You need to make sure that you know what options that surgeon has available to them, and which they plan to use in your particular case.”
Urinary Reconstruction and Diversion
If the bladder is removed, it may be necessary to construct a bladder substitute from a portion of the intestine or an external bag. The flow of urine is then diverted or rerouted to the appropriate substitute.
Reconstruction and diversion is generally an advanced procedure. While it can be done either open or robotically, more surgeons are trained to perform as an open procedure.
There are three main ways to reroute the urinary tract:
- Ileal conduit urinary diversion: Diverts urine through a stoma into a bag outside the body; the bag is emptied several times throughout the day
- Cutaneous continent reservoir (also knows as “Indiana pouch”): Uses a portion of your intestines as a pouch to collect urine; a thin catheter is passed through a stoma to collect urine at regular intervals throughout the day
- Orthotropic neobladder: Uses a portion of your intestines as a reservoir for urine; urine passes from this reservoir through the urethra and is released from the body in a similar fashion as a natural bladder
Your surgeon will make reconstruction and diversion recommendations based on your health, length of intestines and your general lifestyle preferences.
How Do I Decide Which Bladder Cancer Surgery is Best?
Robotic cystectomy provides some advantages over open cystectomy, including less pain, quicker recovery and reduced scarring. However, in some cases, open surgery may be a better choice. Your surgeon may be trained to perform a specific procedure, so it’s important to discuss their experience with each surgery method.
To date, most studies comparing open and robotic bladder cancer surgery suggest that the two approaches result in similar outcomes. The best way to decide which surgery is best for you may be to consult with a surgeon experienced in both types of procedures.
Rather than feeling trapped by the procedure, you can take charge of your future and make an informed decision about your bladder cancer treatment plan. You are in control.