Types Of Surgical Techniques
- Endoscopic surgery: A thin, flexible tube equipped with a camera and surgical tools is inserted into a natural opening so no incision is made in the skin.
- Keyhole surgery: This minimally invasive procedure involves several small incisions in the skin to access the bladder, and the cancer is removed through these holes using special instruments.
- Robotic surgery: Similar to keyhole surgery, robotic surgery differs in that the actual surgery is done via mechanized instruments instead of a surgeons hands controlling the instruments.
- Open surgery: With an open approach, a traditional large incision is made in the abdomen to access the bladder.
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There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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Preparing For Your Surgery
You and your healthcare team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you arent sure.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin , clopidogrel , enoxaparin , dabigatran , apixaban , and rivaroxaban . There are others, so be sure your doctor knows all the medications youre taking.
- I take prescription medications , including patches and creams.
- I take over-the-counter medications , including patches and creams.
- I take dietary supplements, such as herbs, vitamins, minerals, and natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator , or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I am allergic to certain medication or materials, including latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I use recreational drugs.
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
Here are things you can do to prevent problems before your surgery:
About smoking
About sleep apnea
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine for sleep apnea, bring it with you the day of your surgery.
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What Foods Should I Avoid
Theres no standard diet that people should follow after gallbladder removal surgery. In general, its best to avoid fatty, greasy, processed, and sugary foods.
Eating these foods after having your gallbladder removed wont cause serious health problems, but it can lead to a lot of painful gas, bloating, and diarrhea. This is partly because bile flowing freely into your intestine works like a laxative.
Will My Physical Activity Be Restricted After Surgery
It is critical to remain active even while you are recovering from surgery. Walking every day is important and will speed up the healing process, decrease depression, and increase muscle tone. It takes approximately 6 weeks for the surgical area to heal completely. Please do not do any heavy lifting, strenuous exercises, or excessive stair climbing during this time. You may drive a car 3 to 4 weeks after surgery if you feel well and are not taking any more prescription pain medications.
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What Happens During Gallbladder Removal Surgery
There are 2 main ways of removing a gallbladder:
- laparoscopic cholecystectomy several small cuts are made in your tummy and fine surgical instruments are used to access and remove your gallbladder
- open cholecystectomy a single larger incision is made in your tummy to access and remove your gallbladder
Keyhole surgery is used most often because you can leave hospital sooner, recover faster and are left with smaller scars than with an open procedure.
Both techniques are performed under general anaesthetic, which means youll be asleep during the operation and wont feel any pain while its carried out.
Device Issues And Urinating In A New Way
Tami Walker is a WOC nurse at the University of Michigan, and she sees her job as not only treating patients physical wounds, but also rebuilding their self-esteem. The surgeon goes through a lot of the clinical part of it, Walker says, but not how to live every day. Although Walker counsels some neobladder patients pre-operatively, she spends most of her time helping patients with their urostomies: Walker introduces them to different pouching systems shows them how they attach to the stoma, empty out, and need to be replaced and provides direct care for complications.
General leakage from not having the proper fit is the biggest problem, she says. The adhesive on urostomy pouches doesnt always stick well to a patients abdomen, especially as their body contour shifts in the first eight weeks after surgery.
Months after her operation, Florida resident Nikki Saltzburg, 44, is still trying to figure out how her stoma works. Every time she changes her urostomy bag, she carries a toolbox of materials into the bathroom: an anti-adhesive aerosol to remove the old pouch, a stencil and pair of scissors to cut a hole in the new pouch, a sticky paste to attach the pouch to her stoma, and a handheld fan to dry her skin. It still takes me a while, and the challenge is the stoma doesnt stop leaking urine, Saltzburg says, so urine can be running down your stomach or spraying somewhere.
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What Is A Neobladder
A neobladder is type of internal reservoir for storing urine. Using a portion of small intestine, the urologist reconstructs the tubular shape of the intestine and creates a sphere. The surgeon then connects the pouch to the urethra, creating a neobladder, in which case the patient can void normally. By tensing the abdominal muscles and relaxing certain pelvic muscles, the patient is able to push the urine through the urethra.
Managing Life After Bladder Removal
It takes some time to adjust to the changes after bladder removal. Its not uncommon for patients to have difficulty controlling their bladder following surgery, depending on the urinary diversion that is done. For this reason, incontinence pads or briefs may need to be worn for a period of time. Patients can also expect regular follow-up care and appointments to ensure the urinary diversion drains appropriately.
Doctors typically advise restricting certain strenuous activities until about six weeks post-surgery. These activities include lifting, driving, bathing, and even working, depending on your profession.
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What Can I Expect From This Procedure
We personalize treatment plans to each individual patient. Some patients are best treated with an open operation. Many patients can now be treated using a robotic-assisted laparoscopic operation. In the open operation, an incision is made in the abdomen from the navel to the pubic bone. In the robotic-assisted laparoscopic operation, 6 small incisions are created to insert the laparoscopic ports during the cystectomy portion of the surgery. A small incision is made in the abdomen to remove the bladder and lymph nodes as well as to create the urinary diversion, although this is done robotic-assisted laparoscopically in selected patients. Advantages of the robotic-assisted laparoscopic surgery can be decreased blood loss, earlier return of bowel function, shorter hospital stays, and earlier return to full activities.
Preparing For A Radical Cystectomy
Once your surgery date has been scheduled, youll receive Your Guide to Radical Cystectomy: Preparing for and Recovering from Surgery. This booklet provides checklists for tracking each step you need to take before and after surgery, details about what to expect throughout each stage of the process, and instructions on what to do, what to bring and where to go on the day of surgery. At Johns Hopkins, we have developed an enhanced recovery after surgery critical care pathway to improve outcomes of our bladder cancer patients undergoing radical cystectomy.
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What Is A Cystectomy
A cystectomy is an operation to remove the whole bladder.
This operation is one of the main treatments for muscle-invasive or locally advanced bladder cancer. You may also be offered this treatment if you have very high-risk non-muscle-invasive bladder cancer or bladder cancer that comes back after BCG treatment.
Some people with rarer types of bladder cancer may be able to have only part of their bladder removed. This is called a partial cystectomy.
Your operation will usually involve removing some areas close to the bladder, as well as the whole bladder.
Before surgery, your surgeon or specialist nurse will explain the operation and the effects this may have on your life. This includes possible effects on your sex life and fertility.
How Is Bladder Tumor Biopsy And Resection Performed
You may have general anesthesia for this procedure, which means youll be asleep for it. Some providers might use regional anesthesia, which means youll be awake. However, you wont feel any pain.
Bladder tumor biopsy and resection is performed when a doctor inserts a rigid instrument called a resectoscope into the bladder through the urethra. Inserting the resectoscope in this way means that no incisions are necessary.
Your provider will use the resectoscope to remove the tumor, which will be sent to a pathology lab for testing. Once the tumor is removed, your doctor will attempt to destroy any remaining cancer cells by burning the area using electric current by a process called fulguration or cauterization.
Your provider may decide to insert some type of chemotherapy medicine into the bladder using the scope. This is called intravesical chemotherapy. Your provider might suggest that you have maintenance intravesical chemotherapy for a period of time, meaning that youll have regular treatments.
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What Happens When Your Kidneys Fail
Kidneys act as a natural filter for all the waste products produced in the body, they also help to regulate the fluid and electrolyte balance. They help to keep the blood pressure within normal limits and secrete a hormone which helps in red blood cell production.
When kidneys fail to perform their normal function, the waste products accumulate in the blood and the fluid balance is disturbed, this is termed as kidney failure on ESRD , which can happen gradually or suddenly. People with ESRD need dialysis or transplant to sustain life.
In The Operating Room
Just before surgery, you will be connected to monitors, given blood thinners to prevent clots if needed, and given antibiotics to prevent infection. Then, the anesthesiologist will put you to sleep with a general anesthetic. Usually, surgery takes four to six hours. The OR nurse and recovery team will update your family periodically during this time.
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What Happens Before The Operation
You will be admitted to the hospital the day of your operation. The anesthesiology team will talk to you about their portion of the surgery. If you are a candidate, you may receive an epidural, which is a good option to manage post-surgery pain. The usual hospital stay is 6 to 8 days. On the day of surgery, your family can wait for you in the surgical waiting area on the first floor of the Ronald Reagan Hospital . It usually takes 4 to 8 hours to complete this operation. On completion of the operation the surgeon will contact your family there.
A portion of your intestines will be used to create the urinary diversion. It is important that the entire intestine be clean before surgery, and that you prepare your gastrointestinal tract prior to admission to the hospital. Your surgeon will provide you specific instructions for the bowel preparation.
Why Open Gallbladder Removal Is Done
Unfortunately, the gallbladder isnt always the most efficient organ. Bile can be thick and create blockages along the pathway where it typically empties. The gallbladder is also prone to develop gallstones in certain people.
Gallstones are hard deposits of substances in the bile that can get stuck inside the gallbladder and biliary ducts. They can be as small as a grain of sand or as large as a golf ball. Gallstones can also lead to acute or chronic gallbladder inflammation, sometimes with an associated infection, which can cause:
A surgeon will remove your gallbladder if gallstones cause significant pain and other complications.
Other conditions that could make you a candidate for gallbladder removal include:
- Biliary dyskinesia. This occurs when the gallbladder doesnt empty bile correctly due to a defect in its motion.
- Choledocholithiasis. This happens when gallstones have moved to the common bile duct where they may be stuck, causing a blockage that doesnt allow the gallbladder or rest of the biliary tree to drain.
- Pancreatitis. This is inflammation of the pancreas.
A doctor will recommend gallbladder removal if your gallbladder is causing a severe, acute problem or has become a chronic concern. Some symptoms that may indicate the need for gallbladder removal include:
Risks of open gallbladder removal include:
- allergic reaction to anesthesia or other drugs
- excessive bleeding
- injury to the bile ducts or small intestine
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Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer.
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What Is The Cystectomy Pathway
The Cystectomy Pathway is a carefully designed program, created by Roswell Parks experts, that is like a personal training regimen that you would follow to run a marathon. Following the pathway helps prepare you for the surgery and its life-changing impact. This means your care will involve several specialists before your surgery, during your inpatient stay, and over the weeks and months after your surgery. These include:
- Oncology nurse coordinator who will coach you through the pathway and arrange for your care with the rest of the team.
- Dietitian who will help you improve your nutritional status to boost your strength and energy, promote treatment tolerance and healing, prevent loss of muscle mass, and reduce infection risk.
- Social worker to provide support and resources for anxiety, depression, substance use, financial struggles, caregiver issues, and to arrange your home care.
- Physical and occupational therapists who will assess your current status and teach you exercises to improve your physical strength, functional ability, fine motor skills and respiratory function both before and after your surgery.
- Ostomy nurse to prepare you for life with an ostomy, an opening in your abdomen through which you will empty your urine from now on, if an ileal conduit is planned.
- Dedicated physician assistants and nurse practitioners, specializing in bladder cancer care.
- Support group specifically for bladder cancer patients
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How To Prepare For Open Gallbladder Removal
Prior to surgery, youll undergo several tests to ensure youre healthy enough for the procedure. These will include blood tests and imaging tests of your gallbladder.
You may need to have additional imaging studies, such as a chest X-ray or an EKG, depending on your medical history. A complete physical exam and record of your medical history will also be needed.
During these appointments, tell your doctor if youre taking any medications, including over-the-counter drugs or nutritional supplements. Certain medications can interfere with the procedure. You may have to stop taking them prior to surgery. Also, tell your doctor if youre pregnant or may be pregnant.
Your doctor will give you complete instructions on the best way for you to prepare for surgery.
These instructions may include:
How Might My Life Change After My Kidney Is Removed
People who have only one kidney after a nephrectomy need ongoing care to monitor kidney function. You will need urinalysis and blood tests at least once a year.
You will also have to stay away from activities that increase your risk of kidney injury. For example, you should avoid high-contact sports such as hockey, football or wrestling.
A note from Cleveland Clinic
During a nephrectomy, surgeons remove all or part of your kidney. Healthcare providers may use nephrectomy to remove a tumor or remove a kidney for donation. While most people are born with two kidneys, you can usually function well with only one. You should be able to return to normal activities about six weeks after surgery. After nephrectomy, youll need follow-up care to keep an eye on the function of your remaining kidney.
Last reviewed by a Cleveland Clinic medical professional on 05/02/2021.
References
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