Near-infrared guided robotic partial cystectomy for urachal adenocarcinoma using the da Vinci Xi Firefly platform

Partial cystectomy is considered an optimal bladder-preserving surgical treatment for patients with adenocarcinoma confined to the urachus. This case report describes the use of intraoperative near-infrared fluorescence imaging to fully resect a urachal adenocarcinoma in a partial cystectomy and ensure clear oncological margins while preserving bladder function. The patient described was a male in his 50s who presented to the emergency department with visible haematuria. Both CT and MRI imaging, combined with transurethral resection of the lesion, confirmed a urachal adenocarcinoma. The patient was scheduled for a near-infrared-guided robotic partial cystectomy and pelvic lymph node dissection using Firefly imaging and intraoperative transurethral resection of the bladder tumour. During the procedure, Firefly imaging on the da Vinci Xi robot, combined with cystoscopic transillumination of the tumour, enhanced the surgeon's ability to confidently resect the tumour while sparing the adjacent healthy bladder tissue. The patient recovered well postoperatively and was discharged from hospital after 48 h. A CT cystogram after 4 weeks confirmed that the bladder defect was closed and that the patient was able to void urine without a catheter. Histological analysis confirmed that the tumour had been fully resected and that all pelvic lymph nodes were clear of metastatic disease; however, muscle invasion was present (pT2 disease). This case demonstrates the feasibility of performing a near-infrared-guided robotic partial cystectomy for urachal adenocarcinoma, offering surgeons the ability to confidently resect urachal tumours in a partial cystectomy by providing clear oncological margins and preserving bladder function.