Robotic Radical Cystectomy with Urinary Diversion

Robotic radical cystectomy is an advanced, minimally invasive procedure primarily used to treat muscle-invasive bladder cancer and select high-risk cases of non-muscle invasive disease. This technique utilizes robotic-assisted technology to allow for greater precision, enhanced visualisation, and improved dexterity during surgery. Through a series of small incisions, the bladder is removed along with nearby lymph nodes and, in some cases, surrounding organs, depending on the extent of the disease.

One of the key advantages of the robotic approach is the potential for reduced blood loss, less postoperative pain, and a quicker return to normal activities compared to traditional open surgery. Following bladder removal, a urinary diversion is required to reroute urine from the kidneys out of the body. The type of diversion depends on several factors, including patient preference, cancer characteristics, and overall health status.

Common forms of urinary diversion include:

• Ileal conduit: A small piece of the intestine is used to create a passageway (or conduit) for urine to flow from the kidneys to an external stoma (opening on the abdomen), where it is collected in a urostomy bag.

• Neobladder: A new bladder is constructed from intestinal tissue and connected to the urethra, allowing for more natural urination.

• Continent cutaneous diversion: An internal pouch is created to store urine, which is drained periodically through a catheter inserted into a small stoma.

Robotic radical cystectomy with urinary diversion represents a highly effective, technologically advanced option for appropriately selected patients, aiming to optimise both cancer control and quality of life.