AB006. SOH25_AB_292. Laparoscopic assisted cystoscopic laser beam excision of complex urachal cyst and partial cystectomy

Background: The urachus and the urachal remnants represent a failure in the obliteration of the allantois at birth that connects the bladder to the umbilicus. After birth, it obliterates and presents as the midline umbilical ligament. Among urachal anomalies, the incidence of urachal cysts is 30% to 54%. The incidence in the adult population is of about 1:5,000 while in paediatrics of about 1:150,000. Complete excision is indicated both in case of persistent symptomatic remnants (umbilical discharge, recurrent infection, abdominal pain, urinary symptoms) and (when asymptomatic) there is a risk of malignant trans-formation.

Methods: In this video, we are demonstrating laparoscopic assisted cystoscopic laser beam partial cystectomy for complex urachal cysts. Our aim is to show tips that may improve the outcome of laparoscopic excision of urachal cyst or partial cystectomy; these include use of cystoscopy and intra-vesical laser beam to outline the area of interest and assist in marking the safety margins.

Results: The main challenge when performing such surgery is to identify the margins clearly and to achieve complete excision. Using cystoscopy and laser beam on the table helps in urachal cyst identification, as this is always more prominent intra-vesically than intra-abdominally. This is especially important in the setting of decreased tactile feedback during laparoscopic surgery.

Conclusions: This is an educational video that can help trainees and urologists overcome challenges associated with urachal surgery.

Keywords: Urachus; urachal remnant; cystectomy; laser beam; partial cystectomy