V1883 ROBOT-ASSISTED LAPAROSCOPIC EXCISION OF A URACHAL DIVERTICULUM UTILIZING CO2 BLADDER INSUFFLATION TO MINIMIZE SIZE OF CYSTOTOMY

Abstract

You have accessJournal of UrologyBladder Oncology & Reconstruction1 Apr 2011V1883 ROBOT-ASSISTED LAPAROSCOPIC EXCISION OF A URACHAL DIVERTICULUM UTILIZING CO2 BLADDER INSUFFLATION TO MINIMIZE SIZE OF CYSTOTOMY Lydia Laboccetta, Samuel Deem, and Jonathan Picard Lydia LaboccettaLydia Laboccetta Charleston, SC More articles by this author , Samuel DeemSamuel Deem Charleston, SC More articles by this author , and Jonathan PicardJonathan Picard Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1986AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The discovery of a urachal remnant is a rare finding in the general population. These anomalies may be either benign or malignant, symptomatic or asymptomatic. The pathologic spectrum can include a patent urachus with umbilical drainage, a urachal cyst or abscess, a urachal diverticulum, or a urachal carcinoma. We present our experience with robot-assisted laparoscopic excision of a symptomatic urachal diverticulum. Our patient is a 50 year old female who presented with complaints of urinary urgency, and frequency without incontinence and history of recurrent urinary tract infections. She was found to have microscopic hematuria which led to computed tomography (CT) imaging that identified a calcification inside a urachal remnant located at the dome of the bladder. Cystoscopy revealed an indentation in the dome of the bladder, but no visible stone or patent orifice. She elected to undergo robot-assisted laparoscopic excision of the anomaly to alleviate her symptoms. METHODS After being apprised of the risks and benefits of the procedure, the patient was taken to the operating room where we performed an umcomplicated robot-assisted laparoscopic excision of her urachal remnant. The camera port was positioned in a supra-umbilical location in order to accommodate full visualization of the urachus. Dissection was performed along the urachus to the level of the bladder. Carbon dioxide instilled through a 16 french bladder catheter was utilized to insufflate the bladder for identification and cystotomy planning. A small, circumferential cystotomy was then made and the urachus was removed en bloc. The bladder was closed in two layers and left to catheter drainage. RESULTS The patient was discharged home within 24 hours. CT cystogram obtained 2 weeks later revealed no leak, and her catheter was removed. Pathology of the specimen revealed no malignancy. CONCLUSIONS Robot-assisted laparoscopic surgery provides a minimally-invasive approach to management of all types of urachal lesions. The laparoscopic approach affords excellent visualization of the entire urachus with improved cosmesis compared to traditional surgery. CO2 insufflation of the bladder minimizes the potential morbidity of partial cystectomy. Benign urachal lesions can simply be excised after full evaluation for malignancy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e754 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lydia Laboccetta Charleston, SC More articles by this author Samuel Deem Charleston, SC More articles by this author Jonathan Picard Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...