While laparoscopic urachal excision in children has been well reported, there is limited data on a robot-assisted surgical (RAS) approach. The hidden incision endoscopic surgery (HIdES) technique is an established method of eliminating visible scars following a number of RAS urologic procedures. We report our experience using a robotic approach to treat urachal anomalies in children, and present the first description of utilizing the HIdES port configuration for this procedure.
We retrospectively reviewed pediatric patients who underwent resection of a urachal remnant at our institution from 2013 - 2018. Surgical techniques were either the traditional open approach (OA) or robot-assisted surgery (RAS). HIdES trocar placement configuration was employed in all robotic cases. Patient demographics, perioperative data, pathology reports, and outcomes were abstracted and compared.
23 patients underwent a urachal remnant resection in the study period (RAS: 14 patients vs. OA: 9 patients). RAS patients were older (8.5 vs. 2.0 years, p = 0.031) and weighed more than OA patients (36.1 vs. 13.9 kg, p = 0.063). Median operative time for RAS was longer than OA operative times (136 mins vs. 33 mins, p <0.01). Fewer RAS patients were outpatient compared to OA (7.1% vs. 66.7%, p <0.01), but with a median LOS of 1 day (0 - 1 day). Two patients (14.3%) in the RAS group experienced post-operative complications within 1 week of the procedure compared to 1 (11.1%) in the OA group. There was no significant difference in blood loss, post-operative narcotic requirements, or duration of follow-up between both groups.
RAS is a safe and feasible alternative to open surgery for urachal anomalies. Complete excision can be achieved using HIdES port configuration, allowing for excellent cosmetic outcomes superior to traditional surgical scars without limitation to essential surgical ergonomics.
Journal of endourology. 2020 Feb 04 [Epub ahead of print]
Tijani S Osumah, Candace Granberg, Mohit Butaney, Derek J Gearman, Mohamed Ahmed, Patricio C Gargollo
Mayo Clinic, 6915, Urology, 200 First Street SW, Rochester, Minnesota, United States, 55905-0002; ., Mayo Clinic Minnesota, 4352, Urology, Rochester, Minnesota, United States; ., Mayo Clinic, 6915, Urology, 200 1st St SW, Rochester, Minnesota, United States, 55905-0002., Mayo Clinic, Urology, Rochester, Minnesota, United States; ., Mayo Clinic, 6915, Urology, Rochester, Minnesota, United States; ., Mayo Clinic, Urology, Rochester, Minnesota, United States; .