Robotic urachal cyst removal: Video case report and tutorial for robotic surgical trainees

Background The urachus is a fibrous cord that arises from the anterior bladder wall and extends to the umbilicus, degenerating after birth [1]. Urachal cysts are congenital abnormalities resulting from incomplete obliteration of the urachus into the median umbilical ligament [2], [3], [4]. The cyst often remains asymptomatic but can present with symptoms associated with urinary tract infection, abdominal pain, erythema, swelling, and hematuria [5]. When left untreated, can lead to severe complications like rupture and sepsis [6]. Definitive treatment is with excision, which can be performed via an open, laparoscopic, and robotic approach. Objective To present a video case report of robotic-assisted excision of a urachal cyst, highlighting key takeaways for robotic surgical trainees. Methods and Materials We report a 24-year-old previously healthy male who presents with umbilical pain for one week and drainage from the umbilicus for one day. He had a similar episode ten years ago which self-resolved within a day. CT abdomen/pelvis with contrast notable for a 1.8 cm rim-enhancing fluid collection deep to the umbilicus. Patient was treated with a course of Bactrim with resolution of his symptoms and interval imaging notable for resolution of fluid collection. Patient decided to proceed with robotic-assisted excision of urachal cyst due to recurrent infections and drainage. Results Intra-operatively, the urachal cyst was identified and skeletonized to the level of the umbilicus and then down to the level of the bladder. The cyst was excised with a circumferential margin, and the resulting bladder defect that was closed in two layers. After the bladder was filled demonstrating no leak, the urachal cyst was removed without complication. Conclusions Urachal cysts are a congenital anomaly that can present with a wide variety of clinical presentations [7,8]. Robot-assisted removal provides a minimally invasive technique for successful excision of a urachal cyst when indicated.