THE OPTIMAL TROCAR PLACEMENT FOR LAPAROSCOPIC EXCISION OF URACHAL REMNANTS

(Objective) Although laparoscopic excision of urachal remnants has been applied widely, the standard surgical method has yet to be established. The aim of this study, therefore, was to evaluate perioperative outcome and surgical techniques, including the trocar placement at our institution. (Subjects and methods) A total of 20 patients with urachal remnant were treated using laparoscopic surgery between October 2002 and August 2016. 3 trocars were inserted in the peritoneal cavity. Camera trocar was placed at right side of umbilicus and two working trocars were placed at the upper side of umbilicus and right lower quandrant. A 5 mm, 30° angled lens camera was used during operation. (Results) The mean age was 27 years old. There were 16 males and 4 females. The classifications of urachal remnants were urachal sinus (n=18) and urachal diverticulum (n=2). Umbilical excision was performed in 18 case and partial cystectomy were required in 4 cases. 4 trocars were inserted in only one case due to severe adhesion in the peritoneal cavity. Laparoscopic excision was successfully completed in all cases. The mean operative time was 220 minutes and the mean blood loss was minimal. The complications occurred in 5 cases including small intestinal injury (n=2), peritonitis (n=1), wound infection (n=1), intestinal obstruction (n=1) and acute renal failure (n=1) (intestinal obstruction and acute renal failure were occurred in the same case). (Conclusion) Although there are problems such as shortening the operative time and reducing complications, our unique port placement enables good surgical view and easy suturing during partial cystectomy.