Rare use of robotic surgery for removal of large urachal carcinoma

Minimally invasive surgery has been used traditionally for removal of colorectal, gastric and gallbladder disease pathologies with great success. Many advantages have been demonstrated with the addition of robotic surgery, such as 3-D visualization, articulation of instruments and improved surgeon ergonomics while operating. These benefits have allowed the implementation of robotic surgery into new areas. We describe here a rare case of a robotic resection of an urachal carcinoma. A 53-year-old female patient presented to her primary care physician (PCP) with a chief complaint of recurrent urinary tract infections. An initial urinary bladder ultrasound showed a large mass anterior and superior to the bladder, thus prompting an abdominal/pelvic MRI, which confirmed a large complex cystic mass anterior to and abutting the urinary bladder (5.4 × 6.7 × 5.9 cm). A follow-up cystoscopy showed no abnormal findings within the bladder. Based on the patient's symptoms and imaging, a careful evaluation by her PCP, oncology and surgical team prompted for the removal of the mass. Because of the uncertainty, complexity and location of the mass the patient was offered surgical treatment with the da Vinci robot. Histopathology revealed an urachal adenocarcinoma, well differentiated. We present that surgical resection of an urachal tumor can be performed with the da Vinci robot. Robotic surgery can add to the benefits seen with the conventional laparoscopic approach and thus can be an accepted method for treatment of abdominal wall masses.