Umbilical laparoendoscopic single-site technique for complete excision of urachal remnant

Laparoendoscopic single-site surgery for urachal remnant with extraperitoneal approach through a suprapubic port

INTRODUCTION

No standard procedure has been established for laparoendoscopic single-site surgery for urachal remnants (LESS-U). This study aimed to report the novel surgical techniques and initial outcomes of laparoendoscopic single-site surgery with an extraperitoneal approach through a suprapubic port for urachal remnants (spLESS).

METHODS

Fifty-five patients (median age, 27 years; range, 15-69 years) who underwent LESS-U were analyzed. To overcome the limitations inherent in the conventional procedure (LESS-U through an umbilical port: uLESS), we modified the port placement and approached via the extraperitoneal space. spLESS is a novel procedure which reduces intestinal damage caused by the extraperitoneal approach and overcomes incomplete resection of the urachal remnant, especially in the bladder dome. Three trocars are inserted into the extraperitoneal space through a suprapubic port in spLESS, and complete resection of the urachal remnant from the umbilicus to the bladder is performed with an appropriate incision line. Patient characteristics and perioperative results were retrospectively collected. Cosmetic outcomes were prospectively evaluated using self-administered questionnaires (body image and photo-series questionnaire).

RESULTS

spLESS and uLESS were performed in 43 and 12 patients, respectively. No differences were observed between the perioperative results. The cosmetic outcomes were compared between the groups using body image and photo-series questionnaires. No patient developed major complications; there was no recurrence in either group.

CONCLUSIONS

spLESS is a novel procedure which can completely resect the urachal remnant and reduce the risk of intestinal damage. spLESS is a safe, effective, and feasible procedure with high postoperative cosmesis.

Transumbilical laparoendoscopic single-site surgery versus conventional laparoscopic surgery for patients with symptomatic urachal remnants: an experience with 57 patients

PURPOSE

To evaluate the surgical feasibility and postoperative cosmesis of a novel transumbilical laparoendoscopic single-site (LESS) surgical approach involving Y-shaped incisions and three-flap umbilicoplasty in urachal remnant patients.

METHODS

Patients with symptomatic urachal remnants who underwent either conventional laparoscopic surgery (CL group, n = 21) or LESS surgery with Y-shaped incisions and three-flap umbilicoplasty (LESS group, n = 36) between May 2010 and September 2019 were retrospectively assessed. Perioperative factors and postoperative esthetic outcomes were compared between the groups using univariate and multivariate analyses. Esthetic outcomes were assessed using the body image questionnaire consisting of the body image scale (BIS) and the cosmetic scale (CS); a higher score indicated a better outcome.

RESULTS

The median operative time was greater and the insufflation time was shorter in the LESS group than in the CL group. The estimated blood loss and postoperative hospital stay and surgical site infection rate did not differ significantly between the groups. While the BIS score also did not differ significantly between the groups, the CS score was greater in the LESS group than in the CL group. Multivariate analysis revealed that the surgery type (LESS surgery) was an independent predictor of greater postoperative esthetic satisfaction.

CONCLUSION

Transumbilical LESS surgery with Y-shaped incisions and subsequent three-flap umbilicoplasty is feasible in patients with symptomatic urachal remnants. Regarding postoperative cosmesis, the higher CS score suggests that this technique is superior to CL surgery. Furthermore, the selection of this procedure was an independent predictor of good postoperative esthetic outcomes.

Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults

The traditional surgical approach for removing a symptomatic urachal remnant is via a lower midline laparotomy and infraumbilical incision or a laparoscopic approach with umbilicoplasty. We reviewed our experience with umbilicus-sparing laparoscopic urachal remnant excision in a single-center study and evaluated its efficacy versus open approach (OA). This study was a retrospective study. Between March 2012 and September 2016, 32 consecutive patients with symptomatic urachal remnants underwent the umbilicus-sparing laparoscopic approach (USLA) (n = 17) or OA (n = 15). The efficacy, recovery, and long-term outcomes were reviewed. Our Results showed that the clinical characteristics of the patients in each group, such as age, gender, body mass index (BMI), and disease type, had no significant differences (P > .05). No significant difference was found in the surgical procedure times (76.1 ± 15.4 vs 69.2 ± 13.9 minutes, P = .189) and intraoperative blood loss (29.4 ± 13.3 vs 32.2 ± 12.9 mL, P = .543) between the USLA groups and OA groups. However, the mean postoperative hospital stay (patients with bladder cuff excision: 4.1 ± 1.8 vs 6.1 ± 1.4 days, P = .040 and patients without bladder cuff excision: 1.8 ± 0.5 vs 3.6 ± 0.8 days, P < .001) and the time of full recovery (11.2 ± 1.9 vs 15.6 ± 3.1 days, P < .001), the USLA group were both significantly shorter than that of the OA group. No infected recurrence and malignant transformation had occurred at a mean follow-up of 32.4 ± 8.1 and 34.1 ± 8.8 months in USLA group and OA group, respectively. In conclusion, to minimize the morbidity of radical excision, umbilicus-sparing management of benign urachal remnants in adults is a safe and efficacious alternative with superior cosmetic outcomes, postoperative recovery compared with an OA or umbilicoplasty.

Three-flap umbilicoplasty: a novel and preliminary method of laparoendoscopic single-site transumbilical surgical approach for urachal remnants

PURPOSE

Symptomatic urachal remnants are rare benign anomalies affecting young adults. For these patients, both curative treatment and acceptable postoperative aesthetic outcomes are important. Here, we describe a novel transumbilical approach, using Y-shaped incisions and three-flap umbilicoplasty techniques, to improve repair and aesthetic outcomes.

MATERIALS AND METHODS

The clinical and perioperative data of 16 patients (11 men; median age, 25 years; range 16-46 years) who underwent LESS surgery and three-flap umbilicoplasty (LESS group) between December 2013 and March 2017 were analyzed. For comparison, the perioperative data of those who underwent conventional laparoscopic surgery (CL group) between May 2010 and November 2013 at the same institutions were investigated.

RESULTS

The median operative time of the LESS group was longer than that of the CL group (146.5 vs 107 min; p = 0.009). The estimated blood loss and postoperative hospital stay were not significantly different between the two groups. The two perioperative complications were injury to the transverse colon serosa and minor surgical site infection. Both complications were resolved with appropriate management.

CONCLUSIONS

This novel umbilical approach is useful for patients with symptomatic urachal remnants, with the reduction in port-site scarring resulting in good postoperative cosmesis.

Single-Incision Laparoscopy Surgery Excision of an Infected Urachal Cyst: Description of the Technique

Background: Urachal cysts (UCs) are secondary to incomplete obliteration of the embryonic urachal duct and may become symptomatic when infected. Treatment is primarily surgical to excise the infected cyst. Surgical approaches include a lower midline laparotomy or minimally invasive (MI) techniques. Case: We present a case of a young male with an infected UC that was treated with a single-incision laparoscopy surgery. The operative technique is described. Conclusion: This approach is a safe and feasible option for the MI management of UCs.

Laparoendoscopic single-site surgeries: A multicenter experience of 469 cases in Japan

OBJECTIVE

To report on a multi-institutional series of non-robotic urological laparoendoscopic single-site surgery in Japan.

METHODS

Consecutive cases of laparoendoscopic single-site surgery carried out between February 2009 and December 2012 at nine academic institutions were included. We examined the surgical outcomes, including conversion and complications rates.

RESULTS

Four hundred and sixty-nine cases were included in the analysis. The most common procedure was adrenalectomy (n = 177) and the second most common procedure was radical nephrectomy (n = 143). The procedures also included nephroureterectomy (n = 40), living donor nephrectomy (n = 40), pyeloplasty (n = 30), urachal remnant excision (n = 9), simple nephrectomy (n = 7), radical prostatectomy (n = 6) and others (n = 17). The access sites included umbilicus (n = 248, 53%) and other sites (n = 221, 47%). A transperitoneal approach was used in 385 cases (82%), and retroperitoneal approach in 84 cases (18%). The median operation time of all procedures was 198 min. Conversion to reduced port surgery, conventional laparoscopy, or open surgery was noted in 27 cases (5.8%), 12 cases (2.6%), and two cases (0.4%), respectively, with an overall conversion rate of 8.7%. Intraoperative complications occurred in 10 cases (2.1%). Post-operative complications were noted in 29 cases (6.2%), including five major complications (1.1%). No mortality was recorded in this series.

CONCLUSIONS

Non-robotic laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases in Japan. Furthermore, urological laparoendoscopic single-site surgery is a promising minimally invasive surgical option that is feasible for experienced urological surgeons in intermediate-volume centers as well as high-volume centers.

Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

INTRODUCTION

Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex.

PRESENTATION OF CASE

A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively.

DISCUSSION AND CONCLUSION

Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures.

Successful treatment of a patient with an infected urachal remnant via single-incision laparoscopic surgery: Report of a case

We report on a case of an infected urachal remnant successfully treated via a single-incisional laparoscopic technique. An 18-year-old woman was diagnosed with an infected urachal remnant. The center of the umbilicus was pulled and inverted from the skin, and the cephalic side of the urachus was dissected from the umbilicus. A single-incision laparoscopic technique employing ultrasonic coagulating shears was used to dissect the urachal remnant from the stump of the umbilicus to the caudal end. Single-incision laparoscopic excision of the urachal remnant can be used successfully as a minimally invasive technique with optimal cosmetic outcomes.

Recent advances in urologic laparoscopic surgeries: laparoendoscopic single-site surgery, natural orifice transluminal endoscopic surgery, robotics and navigation

Laparoscopic surgery was developed at the end of the 1980s and has been utilized in almost all urologic surgical procedures. It offers the benefits of less invasiveness and earlier recovery than open surgery. The introduction of laparoendoscopic single-site surgery has offered reduced pain and improved cosmetic satisfaction to patients. Scarless nephrectomy has been realized with transvaginal natural orifice transluminal endoscopic surgery in women. The development of surgical robots has decreased the technical difficulty of complicated procedures, shortened the learning curve, and improved perioperative outcomes relative to laparoscopic surgery. Surgical navigation using real-time sonography, augmented reality, fluorescence, or radioisotope images will improve the quality of these surgeries.