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 [2–4]. 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.