Robotic-assisted laparoscopic surgery of urachal anomalies: a single-center experience
Marcelino Rivera1, Candace F Granberg, Matthew K Tollefson
1Department of Urology, Mayo Clinic , Rochester, Minnesota.
Objectives:
Urachal anomalies typically arise from abnormalities in the process of urachal closure. Urachal pathology causes morbidity (pain, umbilical drainage) and may harbor malignancy. Robotic-assisted laparoscopic surgery may be an attractive alternative to the open approach, which has only been studied in rare case reports. Herein, we report our experience with robotic surgery for benign urachal anomalies.
Materials And Methods:
From 2007 to 2013, we identified 11 patients (8 adult, 3 pediatric) who underwent robotic-assisted laparoscopic surgery for urachal pathology. Surgery was performed with a transperitoneal approach with careful dissection starting lateral to the median umbilical vessels, ensuring removal of all urachal tissue from the umbilicus to the bladder. When necessary, cystoscopic evaluation was performed to assist with the intravesical dissection. Patient demographics, postoperative narcotic use (morphine milligram equivalents), pathologic data, and operative time were evaluated.
Results:
There were 4 female and 7 male patients with a median age of 51 years (range, 12-72 years). Median operative time was 85 minutes (range, 51-224 minutes), and median blood loss was 20 mL (range, 5-400 mL). Only 6 patients required narcotics for pain control postoperatively, with a median of 7.5 mg of peroral morphine used. Median length of hospital stay was 1 day (range, 1-2 days), and median duration of catheterization was 5.5 days (range, 1-10 days). One patient underwent concurrent robotic prostatectomy. Pathology was benign in all cases. Median follow-up was 15.5 months (range, 1-18 months). Surgery was well tolerated as only 1 patient had a complication (Clavien class 1; a urinary tract infection treated with oral antibiotics).
Conclusions:
Urachal pathology is well suited to robotic-assisted laparoscopic surgery. The urachus is immediately visualized upon entry into the abdomen. The procedure can be performed safely, with short hospitalization and minimal narcotic pain control required.