Cystectomy
| Anesthesia type |
General / Neuraxial |
|---|---|
| Airway |
ETT |
| Lines and access |
Partial: PIV x 1 (20) |
| Monitors |
Partial: Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative |
hemorrhage, wound infection, DVT, UTI, ureterointestinal leakage, ileus |
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| User likes | 0 |
A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is performed to address cancer.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- If spinal used, ensure T4 sensory level
- Consider using epi in spinal to prolong block
- Can consider placing epidural if significant post-op pain anticipated
Intraoperative management
Monitoring and access
- 2 PIVs for open, radical, or robotic cystectomy (18g+)
Induction and airway management
- GETA
Positioning
- Supine
- Sometimes females placed in lithotomy
Maintenance and surgical considerations
- If radical cystectomy, have T&S and consider T&C 2 units
- Some centers use indocyanine 25mg to visualize blood flow to the ureters
Emergence
Postoperative management
Disposition
- PACU
Pain management
Potential complications
- Bleeding
Procedure variants
| Radical cystectomy | Partial Cystectomy | Open cystectomy | Minimally invasive cystectomy | Robotic cystectomy | |
|---|---|---|---|---|---|
| Unique considerations | Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells | Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion | Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created. | ||
| Position | Supine, sometimes lithotomy for females | Supine | Supine, one or both arms out | Steep Trendelenburg | |
| Surgical time | 4-6 hours | ~ 2 hours (urinary diversion not required) | ~ 4-6 hrs | ||
| EBL | 300-1500 | Minimal | 1000mL | 100-200mL | |
| Postoperative disposition | PACU | ||||
| Pain management | 2 | ||||
| Potential complications |