ASSISTED LAPAROSCOPIC PARTIAL CYSTECTOMY AND URACHAL RESECTION FOR URACHAL
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PHILIPPE E. SPIESS,
JOSE J. CORREA
Division of Urology, H. Lee Moffitt Cancer Center, Tampa,
and Objective: Standard treatment for urachal adenocarcinomas is open
partial cystectomy and urachal resection; however, minimally invasive
surgical approaches including laparoscopic and recently described robotic
assisted laparoscopic partial cystectomy and urachal resection is feasible
with potential less morbidity. A case of robotic assisted partial cystectomy
and urachal resection for urachal adenocarcinoma is presented. Few articles
in the literature have being published describing this technique and to
the best of our knowledge, this is the largest and potentially most complex
case approached in such a manner.
Methods: A 55 years old African American
male presented with hematuria and mucosuria, cystoscopy demonstrated a
tumor involving the dome of the bladder. Transurethral biopsy confirmed
a urachal adenocarcinoma. Further studies revealed a negative metastatic
evaluation. Preoperative abdominal/pelvic CT imaging revealed an enhancing
mass extending from the inferior level of the umbilicus to the dome of
the bladder. A total of 6 laparoscopic ports were used. The robotic assisted
laparoscopic dissection was started at the level of the umbilicus, dissecting
lateral to the right and left medial umbilical ligaments up until the
dome of the bladder. A simultaneous cystoscopy with transillumination
to define the bladder boundaries of this mass, with robotic assisted laparoscopic
opening of the bladder, with the entire mass (including bladder component)
excised and sent for frozen pathology for margin evaluation. After specimen
extraction, the bladder was closed in two layers. Total surgery time was
300 minutes and intra-operative blood loss was 150cc.
Results: Final pathology reported a pT2N0Mx
adenocarcinoma with negative margins and negative pelvic lymph nodes.
Patient was started on clear liquids on postoperative day 2 and on regular
diet on postoperative day 3. He was discharged on postoperative day 4.
A cystogram perfomed on postoperative day 7 revealed a good bladder capacity
(350 cc) and no leakage was identified.
Conclusions: Robotic assisted partial cystectomy
and urachal resection for urachal adenocarcinoma of the bladder is feasible
even in challenging cases. This surgical approach is less morbid in terms
of postoperative pain and cosmesis when compared to the open standard
approach. The postoperative recovery is faster; however, application of
oncological principles and comfort with laparoscopic and robotic surgery
is needed prior to attempting such challenging cases.
Braz J Urol. 2009; 35 (Video #1): 609
Available at: www.brazjurol.com.br/videos/september_october_2009/Spiess_609
August 8, 2009
Division of Urology
H. Lee Moffitt Cancer Center
Tampa, Florida, USA