da Vinci Operation

Robot-assisted intracorporal da Vinci cystectomy (RARC)

The medical implications of a radical removal of the urinary bladder are explained and the individual steps of the operation are described in the following.

In addition, you can find information on the time flow of the da Vinci cystectomy here.


The radical removal of the urinary bladder is carried out in the case of bladder cancer which has already grown into the bladder muscles and cannot be healed by scraping with cystoscopy.

Another necessity to remove the urinary bladder can be e.g. a contracted bladder. A contracted bladder is a strongly reduced bladder as a result of radiation or infections which no longer funtions normally.

After the operation of the bladder, a new reservoir must be created for the urine.

Here there are different possibilities.
The two most frequently used urinary diversions are:

1.) The ileal conduit
Here a part of the small intestine is disconnected and the urinary ducts inserted into it. Then the small intestine is diverted through the abdomen and sutured into the skin. The urine flows via the small intestine into a pouch (= incontinent urinary diversion).

2.) The neobladder
In the case of the neobladder, a longer part of the small intestine is also disconnected. It is completely sutured into a new bladder, in which the ureters are then sutured, in the abdomen. The neobladder is sutured at the urethra and is thus located in the same position as the original urinary bladder (= continent urinary diversion).

The two urinary diversions cannot be used in every patient.

Comprehensive advice on therapy options is always provided during our da Vinci consulting hours.

Sequence of the operation:

The operation starts with the setting of the trocars. These are 6 small sleeves that are inserted into the abdomen via cuts that are approx. 1 cm long. The fine da Vinci instruments are inserted via these sleeves.

After this, the two ureters are prepared and deposited right before the bladder. In men, the urinary bladder is removed together with the prostate and the seminal vesicles. A nerve preservation of the nerve fibres which are important for an erection is possible. In women, the urinary bladder is removed with the uterus, ovaries and front vaginal wall.

This is then followed by an extensive removal of the lymph nodes in the minor pelvis.

Then a part of the small intestine is disconnected from which either an ileal conduit or a neobladder is sutured. The remaining small intestine is stitched back together. Both the lymph nodes and the urinary bladder are put into specimen pouches which are removed via one of the trocar cuts at the end of the operation.

In the case of the neobladder, the bladder made of intestine is fixed to the urethra with a circular watertight suture and the ureters are implanted.

In the case of the ileal conduit, the ureters are sutured, the small intestine part is led through the abdomen and sutured in the skin of the abdomen.

The ureters are splinted to allow for a reasonable growth of the neobladder or the ileal conduit.

The small wounds are closed intracutaneously wih biodegradable sutures.

In most cases, with this surgical technique, the blood loss is low (approx. 300 ml).

The entire operation is carried out with the da Vinci system so that no larger abdominal cut is necessary.

This surgical technique was carried out nationally for the first time in 2013 at the Hanover da Vinci Centre.