When bladder cancer invades deep into the wall of the bladder, it is usually necessary to surgically remove the bladder (radical cystectomy). However, if the tumor is isolated to a relatively small area away from the opening of the bladder, partial removal of the bladder (partial cystectomy) may be all that is required. Traditionally this procedure has been performed through a large incision in the lower abdomen, resulting in a potentially long recovery. Laparoscopic removal using small “button-hole” size incisions can reduce the operative risk and recovery time. This technique can also be used to remove an abnormal portion of the bladder for reasons other than cancer.
Similar to other laparoscopic procedures, the surgeon makes a button-size incision in the center of the abdomen for the insertion of a surgical telescope. After expanding the body cavity with carbon dioxide gas, three or four additional small incisions are made to place narrow tubes used for interchangeable instruments. The surgeon can then visualize the internal organs and the interchangeable instruments on a television monitor.
The abnormal area of the bladder is fully exposed. Identification of this area is often facilitated by simultaneously looking inside the bladder through the normal urinary channel (urethra) with an additional telescope (cystoscopy). A far-away incision is made in the bladder entirely around this abnormal area. Without allowing the detached portion of the bladder to touch any other structures, it is placed in a protective plastic bag that closes with a purse-string (all while inside the body). The resultant bladder opening is meticulously repaired with dissolvable suture. The bladder is filled with water to test the closure. The bladder tissue is removed in one piece, usually with minimal enlargement of the small “button-hole” incision used for the telescope. A separate small drainage tube is temporarily (usually less than 2 days) left in place. The urinary drainage catheter remains for approximately one week. The skin openings are closed with shower-resistant glue as a substitute for both stitches and bandages.
Results & More
Laparoscopic partial cystectomy facilitates quicker recovery, less pain, and a lower complication rate as compared to the typical open-incision partial bladder removal. Obviously, the primary goal is cancer cure. Our cure rates have either matched or surpassed any other published series for open-incision partial bladder removal. A vast experience and a world-class surgical team help ensure this high level of success.
Most patients are discharged from the hospital the day following surgery. Risk of transfusion, urinary leak, damage to surrounding organs, blood clots, pneumonia, and wound infection are each under 1%.
Q: How much pain can I expect after the procedure?
A: Pain is typically less with laparoscopic procedures when compared to open-incision surgery. Some abdominal cramps and shoulder discomfort can occur from the carbon dioxide gas used during surgery. This type of pain is best treated with anti-inflammatories rather than narcotics. Although everyone is different, post-operative discomfort is usually easily managed and short-lived.
Q: Is bruising normal after a laparoscopic procedure?
A: When a narrow tube is placed through a button-size skin incision, a small blood vessel just below the skin can break. However, since the snug fit of this tube will compress the blood vessel during surgery, bleeding will often not occur. If this blood vessel were to re-open at a later time, a small amount of blood could track over a large surrounding area (including the genitalia). This is not a true bruise but will have the same appearance. Most important, this finding is not an indication of internal problems.
Q: When can I return to work or other normal activities following my surgical procedure?
A: Scott D. Miller, MD recommends at least two weeks away from work. Very few jobs would require more than four weeks of leave. In many cases, a small amount of light work-related duties are acceptable during the first two weeks. All patients should move around frequently from the time of surgery and resume light exercise at one week (gradually increasing to a normal routine by four weeks). Driving a car is often reasonable in approximately one week if reaction time is good. Of course, Dr. Miller will provide guidance for each individual situation.
Q: How long does the surgery take Dr. Scott Miller to perform?
A: Although many variables can affect the time necessary for Dr. Scott Miller to meticulously perform the surgery, he usually completes the procedure in one to two hours. However, the time away from family members also includes preparation (30-40 minutes), anesthetic reversal (15-20 minutes), and recovery room stay (2 or more hours). Dr. Scott Miller asks patients to arrive two hours prior to this process, during which time family members can remain present. Occasional updates are given to the family by the operating room nurse. Dr. Scott Miller will come to the waiting area when the patient is ready for transfer to the recovery room.
Q: How long do I stay in the hospital following surgery?
A: Most patients are ready for discharge on the day following surgery.
Q: How long will I need a bladder drainage tube (Foley catheter) following surgery?
A: The bladder drainage tube is usually removed 1-2 weeks following the procedure. When a separate abdominal drain is also placed, it can usually be removed in 1-2 days.
Q: Should I donate blood prior to my procedure?
A: Since the risk of needing a blood transfusion is less than 1%, blood donation is not necessary.
Q: When can I shower or bathe following my surgery?
A: Since shower-resistant glue was used as a substitute for both stitches and bandages, showering is acceptable once discharged from the hospital. Although water will not harm the surgical areas, mechanical cleansing of the incisions should be avoided for the first week to prevent premature removal of the glue. Complete immersion such as bathing or swimming is allowed at two weeks.
Q: What long-term follow-up care will I need?
A: In cases of partial bladder removal for cancer, periodic x-rays and telescopic examinations of the bladder (cystoscopy) will be necessary on a long-term basis.
Q: How will partial bladder removal affect my bladder function?
A: Even after removal of a portion of the urinary bladder, most patients will regain all or most of their bladder capacity.
Q: How does the cure rate with laparoscopic partial cystectomy compare to open-incision partial bladder removal?
A: The cure rate for laparoscopic partial cystectomy is equal to open-incision partial bladder removal.