Robot assisted Laparoscopic Cystectomy (RALC)

Why have this procedure?

Cystectomy may be suggested for patients with bladder cancer that has invaded into the muscle layers of the bladder or bladder cancer on the surface of the bladder that is high risk or hasn’t responded to other forms of treatment (e.g. BCG). It can also be a good option for patients who have severe bladder symptoms or uncontrollable bleeding. Another option for treatment is radiotherapy and often patients will receive chemotherapy prior to surgery or radiotherapy to improve the chances of cure. Long term follow up is required in patients who receive this treatment. Patients must be carefully selected for surgery and be aware of the risks involved. Surgery and radiotherapy have their relative risks and benefits and should be discussed with your consultant before choosing the best individual treatment. Cystectomy is primarily performed in the UK for bladder cancer but occasionally will be performed for severe bladder symptoms or bleeding.

Why choose us?

Staffordshire Urology Clinic is one of a few centers in the UK to offer keyhole bladder removal (Laparoscopic Radical Cystectomy). We now usually perform this keyhole surgery robotically (Robot assisted Laparoscopic Cystectomy). The keyhole technique offers a shorter hospital stay, smaller scars (better cosmesis and lower risk of hernias and infection), quicker return to normal activities and less requirement for painkillers following your operation. Laparoscopic surgery also limits the need for intensive care treatment which is often required after an open operation. Not all patients are suitable for keyhole surgery, but Mr Lyndon Gommersall has large experience of performing this surgery open, through a traditional cut.

Coming in for this procedure

Prior to surgery patients will need careful preoperative assessment which will include some general blood tests but also detailed MRI and CT scanning. By limiting the use of preoperative bowel preparation, laparoscopic surgery, early feeding and mobilisation these ‘enhanced recovery principles’ ensure that patients recover from surgery as rapidly as possible. It also limits the risk of surgical complications. On the day of surgery patients will be admitted to hospital and drink up to 2 hours prior to their surgery. 5 small holes are made in the abdomen to facilitate the keyhole surgery. The central hole is made slightly larger to remove the bladder and form a small stoma (urostomy) to drain the urine. Postoperatively patients will be encouraged to return to drinking on day 1 and food from day 2. Early mobilisation is encouraged. Many of our patients will return home 7 days after their surgery (Average 8.4 days). There are risks and side effects associated with all forms of treatment and these should be carefully considered before surgery. Serious complications associated with major surgery (heart, lung, and thrombosis problems that could lead to death) are rare. Damage to the back passage (rectum) or other internal organs is likewise rare. The commonest adverse effects of this surgery are infection, bleeding, sexual problems and wound problems.

Follow-up after this procedure

Regular follow-up is required to ensure that the cancer has been eradicated. It is also important to monitor and treat any problems.

What next?

If you would like to discuss keyhole bladder removal then please contact us and book a consultation with Mr Lyndon Gommersall.