V3-13: Entirely Minimally-Invasive Management of an Infected Urachal Cyst in the Pediatric Patient
VideoIntroductions and Objectives
Urachal cysts are the most common urachal anomaly in the pediatric patient population. Minimally-invasive approaches have become increasingly prevalent in management. We present an approach to entirely minimally-invasive management of a case of an infected urachal cyst utilizing percutaneous drainage and subsequent robot-assisted laparoscopic cyst excision.
After initial ultrasound-guided percutaneous drain placement and culture-specific antibiotics, an adolescent male underwent delayed robot-assisted urachal cyst excision and partial cystectomy for an infected urachal cyst. The steps of this approach are demonstrated in this video, including (1) ultrasound-guided percutaneous drain placement; (2) placement of robotic ports; (3) identification of anatomic landmarks; (4) dissection of the urachal cyst and bladder from the anterior abdominal wall; (5) dissection of the cyst from the bladder; (6) removal of cyst with small cystotomy; (7) bladder closure in two layers; and (8) interrogation of closure with bladder distension. No perivesical drain was left.
The patient was discharged on postoperative day 1. A Foley catheter was left indwelling for three days and removed without need for cystogram. There were no complications and incisions were hidden within the umbilicus and at the level of the Pfannenstiel line, rendering the incisions non-visible when the patient wears a bathing suit.
Entirely minimally-invasive management of the pediatric infected urachal cyst including percutaneous drain placement and subsequent delayed robot-assisted laparoscopic urachal cyst excision with bladder cuff removal is simple, safe, and offers excellent cosmesis.