Robotic Radical Cystectomy for Bladder Cancer in NYC
Robotic radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer (MIBC) and for high-grade non-muscle invasive bladder cancer that has not responded to intravesical therapy. The bladder is removed along with regional lymph nodes, and a new way for urine to leave the body is reconstructed using a segment of small bowel. With the robotic approach, the entire operation, including the urinary diversion, is performed through small keyhole incisions.
Dr. Wei Phin Tan performs robotic radical cystectomy with intracorporeal urinary diversion (ICUD) at NYU Langone Health, Main Campus in Manhattan. He offers two diversion types, ileal conduit and orthotopic ileal neobladder, both reconstructed intracorporeally. Dr. Tan has published peer-reviewed work on intracorporeal cystectomy and urinary diversion technique.
"Cystectomy is one of the biggest operations in urology. The goal is to control the cancer and to set the patient up for the best possible quality of life afterward, which means the right diversion for the right patient and a recovery plan that starts the day we meet, not the day of surgery."- Dr. Wei Phin Tan, MD, MHS, FACS
Who Is a Candidate?
- Muscle-invasive bladder cancer (clinical stage T2 or higher), typically after neoadjuvant cisplatin-based chemotherapy when eligible
- BCG-unresponsive high-grade NMIBC (CIS, T1 high-grade, or recurrent Ta high-grade) in patients who choose surgery over bladder-sparing options
- Recurrent or progressive NMIBC after multiple lines of intravesical therapy
- Selected non-urothelial bladder cancers, including squamous cell, adenocarcinoma, and small cell, in coordination with medical oncology
- Acceptable medical fitness for major surgery, sufficient kidney function for diversion, and adequate functional status
Urinary Diversion Options
After the bladder is removed, urine has to be redirected. Dr. Tan offers two reconstructions, both performed robotically and intracorporeally: ileal conduit and orthotopic ileal neobladder. The right choice depends on cancer location, urethral status, kidney function, lifestyle, and patient preference.
| Diversion | Ileal Conduit | Orthotopic Neobladder |
|---|---|---|
| External appearance | Stoma + ostomy bag on the abdomen | No stoma, urination through the native urethra |
| How urine leaves | Continuous drainage into a pouch | Voluntary voiding through the urethra (may require intermittent catheterization) |
| Best for | Most patients, simplest, most reliable, fastest recovery | Highly motivated patients with adequate kidney function, intact continence mechanism, and clean urethral margin |
| Operative complexity | Lower | Higher |
| Continence | Not applicable (collected in pouch) | Daytime continence usually good; nighttime variable, may need timed voiding |
| Long-term considerations | Stoma care; periodic stoma-related issues | Possible neobladder retention requiring catheterization, mucus production, metabolic monitoring |
This comparison is general. Diversion choice is highly individualized to each patient.
What "Intracorporeal" Means
With a robotic intracorporeal urinary diversion (ICUD), the entire reconstruction (bowel reconfiguration, ureter implantation, and connection to the urethra or abdominal wall) is performed inside the body using the robot, rather than through a larger open incision used in traditional extracorporeal diversion. Dr. Tan has published peer-reviewed work on stentless intracorporeal anastomotic technique and on outcomes of robotic radical cystectomy with intracorporeal urinary diversion.
Selected Evidence (Dr. Tan's Published Work)
- Tan WP, Whelan P, Deane LA. Intentional Omission of Ureteral Stents During Robotic-assisted Intracorporeal Ureteroenteric Anastomosis. Urology. 2017. PMID 28111222
- Whelan P, Tan WP, Papagiannopoulos D, Omotosho P, Deane L. Robotic-assisted laparoscopic radical cystectomy with stentless intracorporeal ileal conduit and ureteroenteric anastomoses. Journal of Robotic Surgery. 2017. PMID 28070738
- Tan WS, Khetrapal P, Tan WP, Rodney S, Chau M, Kelly JD. Robotic-Assisted Radical Cystectomy with Extracorporeal Urinary Diversion: a systematic review and meta-analysis. PLoS One. 2016. PMID 27820855
- Khetrapal P, Wong JKL, Tan WP, et al. Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials. European Urology. 2023;84(4):393-405. PMID 37169638
Full publication list available on the Publications page, pulled live from PubMed.
Pelvic Lymph Node Dissection
An extended pelvic lymph node dissection is performed at the time of cystectomy. This is critical for accurate staging and oncologic control. Lymph nodes from the obturator, internal/external iliac, and common iliac regions are removed and analyzed. The number and quality of lymph nodes removed has a meaningful impact on outcomes.
Perioperative Care and ERAS
- Pre-op optimization: nutritional assessment, prehabilitation, smoking cessation, anemia and frailty screening
- Neoadjuvant chemotherapy for muscle-invasive disease in cisplatin-eligible patients
- ERAS (Enhanced Recovery After Surgery) protocol: minimized fasting, multimodal pain control, early mobilization, early oral nutrition, judicious fluid management
- Stoma teaching and meeting with the ostomy nurse before surgery for patients having ileal conduit or Indiana pouch
- Discharge typically 5 to 7 days after surgery, depending on bowel function and diversion type
Risks and Recovery
Cystectomy is a major operation. The conversation at consultation includes:
- Perioperative risks including bleeding, infection, ileus, urine leak, and venous thromboembolism
- Long-term issues including stoma care, urinary tract infections, kidney function changes, vitamin B12 deficiency (after ileal use), and metabolic changes
- Sexual function changes, including erectile and ejaculatory effects in men and effects related to anterior pelvic exenteration in women
- Quality-of-life adaptation, particularly in the first 6 to 12 months
Surveillance After Cystectomy
- CT imaging and laboratory studies every 3 to 6 months for the first 2 years, then annually
- Urethral surveillance with washes or cystoscopy when applicable
- Upper tract surveillance for new urothelial recurrence
- Vitamin B12, electrolytes, kidney function monitoring long-term