Dr. Amit Goel

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Robotic Radical Cystectomy with construction of Total Intracorporeal Orthotopic Ileal Neobladder / Ileal conduit for Cancer Bladder

What Is Robotic Radical Cystectomy?
  • A minimally invasive robotic surgery to remove the urinary bladder affected by cancer.

  • Performed using the da Vinci Robotic System which provides:

    • 3D magnified view

    • Wristed, precise instruments

    • Tremor-free surgical movements

  • Considered the gold standard for muscle-invasive and high-risk non-muscle-invasive bladder cancer.

  • Entire surgery—including bladder removal and urinary diversion—can be done intracorporeally (inside the body).

After removing the bladder, surgeons create a new path for urine. Robotic surgery allows the entire reconstruction inside the body, leading to:

  • Smaller incisions
  • Less bowel handling
  • Reduced risk of infection
  • Faster bowel recovery
  • Better cosmesis
  • Lower postoperative pain

Two main diversion options:

  1. Orthotopic Ileal Neobladder (new bladder)
  2. Ileal Conduit (stoma-based diversion)

A. Orthotopic Ileal Neobladder

  • A new bladder constructed from a segment of small intestine.
  • Positioned in the same anatomical location as the original bladder.
  • Allows:
    • Passing urine naturally through the urethra
    • Near-normal voiding sensation
    • Better quality of life
  • Suitable for patients where urethra is cancer-free.

B. Ileal Conduit (Urostomy)

    • A segment of ileum is used to create a small tube (conduit).
    • Urine is diverted from the kidneys to a stoma on the abdomen.
    • Collected in an external urostomy bag.
    • Simple, reliable, and preferred for older or high-risk patients.
  • Muscle-invasive bladder cancer (T2 and above).
  • High-grade recurrent non-muscle invasive bladder cancer.
  • BCG-unresponsive carcinoma in situ (CIS).
  • Large tumors occupying the bladder.
  • Tumors involving bladder neck or trigone.
  • Certain cases of urethral cancer.
  • MRI / CT scan of abdomen & pelvis.
  • Cystoscopy and biopsy.
  • Lab tests including kidney function.
  • Anaesthesia evaluation.
  • Nutritional optimization.
  • Bowel preparation as per protocol.
  • Counselling about:

     

    • Type of urinary diversion
    • Lifestyle changes
    • Stoma care (if ileal conduit)
    • Continence training (if neobladder)
  • Better visualization of pelvic structures
  • Less blood loss
  • Lower transfusion rates
  • Reduced bowel dysfunction
  • Smaller incision → faster healing
  • Lower infection rates
  • Shorter hospital stay
  • Precise lymph node dissection
  • Enhanced recovery and early ambulation

A. Radical Cystectomy

  • Performed under general anaesthesia.
  • 5–6 robotic ports placed in the abdomen.
  • Key surgical steps:

    • Isolation and removal of urinary bladder
    • Removal of prostate & seminal vesicles (in males)
    • Removal of uterus, ovaries & part of vagina (in females, if required)
    • Pelvic lymph node dissection (standard or extended)

Ensures complete cancer clearance.

 

Total Intracorporeal Neobladder Reconstruction (if selected)

  1. Ileal Segment Selection
  • 50–65 cm of terminal ileum isolated for creating neobladder.
  • Bowel continuity restored.
  1. Neobladder Construction Inside the Body
  • Ileal segment detubularized and folded into a spherical reservoir.
  • Performs similar to a natural bladder.
  1. Connection to Urethra
  • Neobladder is attached to the urethra for natural urine passage.
  1. Ureter Implantation
  • Both ureters implanted into the neobladder.
  1. Testing & Completion
  • Reservoir checked for leaks.
  • Catheter and stents placed for temporary drainage.

Total Intracorporeal Ileal Conduit (if selected)

  1. Ileal Loop Selection
  • 15–20 cm of ileum chosen.
  1. Ureters Connected
  • Ureters attached to the ileal conduit (Wallace or Bricker technique).
  1. Stoma Creation
  • A small opening (stoma) created on the abdominal wall.
  • Conduit brought out through the stoma.
  1. Stoma Appliance

External urostomy bag used to collect urine.

Hospital Stay

  • Usually 5–7 days (shorter than open surgery).

Bowel Function

  • Faster return due to minimal bowel handling.

Pain

  • Mild; managed with oral medications.

Mobility

  • Walking encouraged on Day

Diet

  • Clear liquids ➝ soft diet ➝ normal diet within days.

Catheters & Stents

  • Neobladder: Catheter for 2–3 weeks until healing completes.
  • Conduit: Stents removed after 10–14 days.

Cancer Control

  • Excellent oncological results with high lymph node yield.
  • Clear surgical margins leading to improved survival.

Quality of Life

With a neobladder:

  • Natural urination through urethra
  • No external appliance
  • Good daytime continence
  • Nighttime continence improves gradually

With an ileal conduit:

  • Reliable urinary diversion
  • Low complication rates
  • Easy stoma care
  • Suitable for older / frail patients

Short Term

  • Bleeding
  • Infection
  • Bowel obstruction
  • Lymphocele
  • Urine leak

Long Term

  • Neobladder:

    • Continence issues (temporary)
    • Mucus production
    • Vitamin B12 deficiency
    • Metabolic acidosis (rare)

  • Ileal Conduit:

    • Stoma-related issues
    • Appliance leakage
    • Skin irritation
    • Robotic approach significantly reduces complication rates.

Orthotopic Neobladder Ideal For:

  • Younger patients (<70 years)
  • Good kidney function
  • Good urethral function
  • Cancer not involving the urethra
  • Motivated for neobladder training

Ileal Conduit Ideal For:

  • Older / medically complex patients
  • Poor kidney function
  • Prior pelvic radiation
  • Urethral involvement
  • Want simplest diversion method

If you or a loved one needs a kidney transplant, consult Dr. Amit Goel, a trusted Urologist & Kidney Transplant Specialist, to discuss robotic or open transplant options and donor procedures.

 

📍 C2/902, Parsvnath Exotica, DLF Phase 5, Sector 53, Gurugram, Haryana 122003  

 

📞 +91 84470 18167

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