In a radical cystectomy, the surgery is performed either in an open or robotic fashion.
- In the open operation, an incision is made from the pubic bone to the belly button.
- In the robotic operation, several small incisions are made to allow introduction of the Da Vinci robotic instruments and camera.
The bladder is removed by the urologist. In a man the prostate is also removed and a vasectomy is performed. In women the uterus and ovaries are often removed; sometimes part of the vagina must be removed also. The surgery also involves removal of pelvic lymph nodes. This offers both diagnostic and therapeutic benefit to the patient.
After removal of the bladder, the urologist uses a segment of the intestines (usually the small bowel) to drain urine. There are different options for urinary reconstruction, and each has advantages and disadvantages. The decision on urinary diversion requires consideration of several factors, including physician and patient preference, extent of disease, an individual’s anatomy and other medical conditions (e.g., kidney function, overall health, age).