Robotic-assisted laparoscopic partial cystectomies (RAPC) for urachal diseases: Intuitive surgery for total umbilical tract excision and umbilectomy

Introduction: The management of urachal nodules or masses include complete urachus excision with partial cystectomy and umbilectomy, for urachal adenocarcinoma is a highly aggressive disease and prognosis is poor in advanced stages. This video aims to present a novel step-by-step robotic-assisted laparoscopic partial cystectomy (RAPC) technique with total umbilical-tract excision and umbilectomy. Methods: A step-by-step RAPC technique: (1) siting of supra-umbilical camera-port (incorporated into subsequent umbilectomy), (2) creation of 3 robotic ports and one 12-mm assistant-port, (3) identification and incision markings of median and medial umbilical ligaments and bladder dome, (4) mobilization of whole urachus from umbilicus caudally to the dome attachment, (5) ‘skeletonization’ of bladder dome to reveal optimal entry site followed by partial cystectomy, (6) 2-layer bladder defect repair using 3–0 barbed sutures, (7) bagging of specimen and excision of urachal attachment at umbilicus en-bloc with umbilectomy. Patient demographics, peri‑and post-operative short-term outcomes were analyzed. Results: Nine consecutive cases of RAPC for urachal lesions were performed from August 2015 to December 2019. Four patients (44.4%) had concurrent umbilectomy performed. Demographics, peri‑and post-operative data are as follows: median age: 60 (44–64) years, median operative time: 190 (160–255) minutes, median estimated blood-loss: 50 (50–125) ml, median hospitalization: 2 days, urinary leakage on cystogram (POD-10): 0. There were two patients who had Clavien-Dindo complications (22%) within 90 days of surgery. Final histology showed adenocarcinoma: 3 (33%), benign urachal nodule: 6 (67%). Conclusions: RAPC is an intuitive and ergonomic approach for total urachus excision and umbilectomy for urachal mass. It represents a minimally-invasive treatment with excellent oncological and cosmetic outcomes.