Robotic Assisted Excision of a Urachal Diverticulum.

To demonstrate a combined robotic assisted laparoscopic technique with concomitant cystoscopy use for excision of a urachal diverticulum, to ensure complete resection of diverticulum and bladder cuff.Step-by-step demonstration and explanation of the procedure using video illustration. IRB/Ethics Committee ruled that approval was not required for this case report, however patient consent was obtained.Vesicourachal diverticula account for approximately 3-5% of congenital urachal anomalies. Although usually asymptomatic, the diverticulum may be associated with an increased risk of urinary tract infections, intraurachal stone formation, and an increased prevalence of carcinoma after puberty. When diverticula become symptomatic or infected, surgical management is warranted.A 68-year-old gravida 0 female was evaluated with cystoscopy for recurrent culture proven urinary tract infections. A suspected vesicourachal diverticulum was identified on cystoscopy, and the diagnosis was confirmed on CT scan. She was counseled on management options and elected to undergo robotic assisted excision of urachal remnant with concomitant cystoscopy.After identifying the diverticulum both laparoscopically and on cystoscopy, the anterior peritoneum was incised in order to dissect the diverticulum off of the anterior abdominal wall. The dissection was carried down to the level of the bladder dome, necessitating entry into the retropubic space of Retzius. A partial cystectomy was performed to ensure complete resection of the diverticulum. The bladder was repaired in two layers. Concurrent laparoscopy and cystoscopy allowed for assurance of water tight closure by retrograde filling of the bladder and observing laparoscopically. Although entered, the space of Retzius is an avascular potential space between the pubic symphysis and the bladder and does not necessitate closure. Surgery was performed successfully without intraoperative or postoperative complications. On final pathology, a benign urachal diverticulum was completely excised. The patient's presenting symptoms resolved postoperatively.Robotic assisted excision of a vesicourachal diverticulum with concomitant use of cystoscopy is a safe, effective and efficient technique for successful, minimally invasive, management of symptomatic urachal diverticula.