Background: Excision of urachal anomalies is indicated for symptomaticremnants or to prevent future malignant degeneration. Open and laparoscopicapproaches have been described as feasible and safe, but may beassociated with a lower midline incision or technical difficulty respectively.Series of successful robotic urachal excision have been reported in adultsbut not in children. We hypothesized that robotic urachal excision withpartial cystectomy of the bladder dome can be applied as a safe and efficienttechnique for these anomalies in pediatric patients.Methods: A retrospective chart review was performed on all patients whounderwent a robotic assisted urachal remnant excision with partial cystectomybetween 2010-2013. Patient demographics, surgical procedural data,surgical outcomes and complications were recorded.Results: A total of 9 patients underwent urachal remnant excision withpartial cystectomy, with median age 10.9 years (range 2.6-18.5 years). 33%of the urachal anomalies were symptomatic, with drainage or history ofinfection. The majority of patients (56%) were found to have urachal cysts,and 22% of patients had a urachal diverticulum. One urachal sinus andone patent urachus were treated in the series. Average size of urachal remnantwas 2.8 cm. Median operative time was 129 minutes, (range 96-238min) with median estimated blood loss of 2cc (range 0-10cc). Urethralcatheter removal and hospital discharge occurred on postoperative day 1in all patients. Postoperative narcotic usage was low; median morphineequivalent=12mg during stay. No complications occurred in the series.Conclusions: Robotic assisted laparoscopic urachal anomaly excision istechnically feasible and safe in pediatric patients. Complication rate islow and the approach is applicable for all encountered types of urachalremnants.
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