Robot-assisted laparoscopic partial cystectomy, urachal resection and pelvic lymphadenectomy for urachal adenocarcinoma

Paolo Fedelini1, Francesco Chiancone1, Maurizio Fedelini1, Marco Fabiano1, Clemente Meccariello1
  • 1 AORN A. Cardarelli, U.O.C. Urologia (Napoli)


This video describes the main steps of robot-assisted laparoscopic partial cystectomy with en bloc resection of the urachus and bilateral pelvic lymphadenectomy for a urachal adenocarcinoma.A 40-year-old man was referred to our attention for episodic gross haematuria and dysuria.Magnetic resonance imaging(MRI) revealed a solid mass in the dome area of the urinary bladder. Diagnostic TURB showed a mucinous adenocarcinoma.With the patient in supine position, five ports are placed transperitoneally.The patient was placed in the 28° Trendelemburg position.After the cranial dissection into Retzius’ space, the bladder dome was excised with the urachus and the umbilicus.The bladder was closed in two layers with continuous running sutures.Bilateral pelvic lymphadenectomy was performed.The operative time was 120 minutes.No intraoperative and postoperative complications occurred.The pathology report described a poorly differentiated adenocarcinoma with extensive extracellular mucin deposition.Two out of seventeen lymph nodes were positive for metastases.The robotic technique is a feasible approach to treat urachal cancer.It can reduce surgical morbidity, postoperative pain, and recovery time, while maintaining the oncologic principle of safe local excision.