V11-11: Trans-umbilical laparoendoscopic single-site excision of urachal remnant with peritoneal repair
VideoIntroductions and Objectives
Urachal remnant infection is relatively uncommon but tends to be recurrent, so that the complete resection of the urachus is essential for the treatment of this disease. Open or laparoscopic technique is employed for urachal resection. Advanced minimum invasive surgery such as laparoendoscopic single-site technique has been also applied to urachal resection. In those cases so far, the divided peritoneum after excision of urachus was left unrepaired without closure. That condition would cause peritoneal adhesion. Our goal is to accomplish both of complete urachal resection and peritoneal restoration closure under pure laparoendoscopic single-site technique.
A 34 year-old male presented with infected urachal remnant was operated. An umbilical semicircular incision was made for transperitoneal approach with SILS® port. A flexible endoscope camera and conventional laparoscopic instruments were used for the surgical procedure. Peritoneal incision was made within medial umbilical ligament, close to the urachus, so as to minimize the defect of peritoneum. After completion of the distal resection, open serosa of the bladder was closed with a figure of eight suture. Then the divided peritoneum was closed with a V-Loc® continuous suture (Figure 1). After the laparoscopic part of the surgery, the umbilicus was totally excised with the entire urachus. Excised skin defect was closed with some foldings with natural appearance like an original umbilicus.
The intended surgical procedure was successfully completed without any perioperative complications. The patient was satisfied with the cosmetic result.
Peritoneal repair after the complete resection of the urachal remnant is feasible even with pure laparoendoscopic single-site technique and it might be mandatory to avoid post-operative peritoneal adhesion.