AB008. 46. Robotic partial cystectomy for urachal tumour with en bloc urachal excision—case presentation and video

Abstract

: Adenocarcinoma of the bladder can be treated with bladder sparing partial cystectomy, with en bloc resection of the urachal remnant and umbilicus. There are few reported cases performed using minimally invasive/robotic surgery. We present the first such procedure performed robotically in Ireland. The patient is a 76-year-old gentleman presenting with gross haematuria, lower urinary tract symptoms and chronic urinary retention, with a background of significant cardiac morbidity and was on permanent antiplatelet therapy. A bladder tumour at the dome of the bladder was found to contain adenocarcinoma, and a staged approach to surgery was initiated. The patient underwent photoselective vaporisation of the prostate (PVP) to eliminate chronic retention and underwent robotic assisted partial cystectomy with en bloc resection of the urachal remnant utilizing the da Vinci Xi® robotic system. The video and discussion addresses port placement; bladder takedown with maintenance of the urachal remnant; demarcation of affected bladder portion with concomitant cystoscopic evaluation of bladder and use of the TilePro® feature; excision of bladder segment and early partial retrieval; bladder closure utilizing double ended barbed suture and en bloc excision of umbilicus, urachal remnant and bladder segment. Discharge was on day 5 post operatively. Cystogram at day 10 showed no leak. The patient remained on his antiplatelet therapy throughout. This case shows that robotic assisted partial cystectomy, in combination with other technologies, can allow even high-risk patients to experience the benefits of minimally invasive surgery.