Single-Port Robot assisted partial cystectomy for urachal adenocarcinoma.

IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY International Braz J Urol Pub Date : 2024-09-01 DOI:10.1590/S1677-5538.IBJU.2024.0379
Sij Hemal, Sina Sobhani, Kevin Hakimi, Shilo Rosenberg, Inderbir Gill
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Abstract

Objective: We present a novel technique to perform single-port (SP) robot-assisted partial cystectomy with excision of the urachal remnant and bilateral pelvic lymph node dissection for urachal adenocarcinoma (1-7).

Materials and methods: A 41-year-old male presented to the clinic for multiple episodes of hematuria and mucousuria. Office cystoscopy revealed a small solitary tumor at the dome of the bladder, with a diagnostic bladder biopsy revealing a tubule-villous bladder adenoma. Cross-sectional imaging of the chest/abdomen/pelvis revealed a 4.5 cm cystic mass arising from the urachus without evidence of local invasion and metastatic spread. He underwent SP robotic-assisted partial cystectomy with excision of the urachal remnant and bilateral pelvic lymph node dissection. Surgical steps include: 1) peritoneal incision to release the urachus and drop bladder 2) identification of urachal tumor 3) intraoperative live cystoscopic identification of bladder mass and scoring of tumor margins using Toggle Pro feature 4) tumor excision with partial cystectomy 5) cystorrhaphy 6) bilateral pelvic lymph node dissection 7) peritoneal interposition flap to mitigate lymphocele formation.

Results: Surgery was successful, with no intraoperative complications, an operative time of 100 minutes, and estimated blood loss of 20 mL. The patient was discharged on post-op day one, and the Foley catheter removed one week after surgery. Final pathology revealed a 7.5 cm infiltrating urachal muscle-invasive adenocarcinoma of the bladder (pT2b). Negative surgical margins were achieved.

Conclusions: Single-port robot-assisted partial cystectomy for urachal adenocarcinoma is safe and can achieve equivalent oncologic outcomes to the standard of care with minimally invasive and open techniques.

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单孔机器人辅助膀胱部分切除术治疗泌尿道腺癌。
目的:我们介绍了一种新技术,在单孔(SP)机器人辅助下进行膀胱部分切除术,同时切除尿道残余物并进行双侧盆腔淋巴结清扫,以治疗尿道腺癌(1-7):一名 41 岁男性因多次血尿和粘液尿就诊。诊室膀胱镜检查发现膀胱穹隆处有一个单发的小肿瘤,诊断性膀胱活检显示为肾小管-膀胱腺瘤。胸部/腹部/盆腔横断面成像显示,尿道处有一个4.5厘米的囊性肿块,无局部侵犯和转移扩散迹象。他接受了SP机器人辅助膀胱部分切除术,切除了尿道残余物,并进行了双侧盆腔淋巴结清扫。手术步骤包括1)腹膜切口,松解尿道并下降膀胱;2)确定尿道肿瘤;3)术中活体膀胱镜确定膀胱肿块,并使用 Toggle Pro 功能对肿瘤边缘进行评分;4)肿瘤切除,部分膀胱切除;5)膀胱造瘘;6)双侧盆腔淋巴结清扫;7)腹膜间皮瓣,以减轻淋巴囊的形成:手术很成功,术中无并发症,手术时间为 100 分钟,估计失血量为 20 毫升。患者在术后第一天出院,术后一周拔除了 Foley 导管。最终病理结果显示,膀胱癌为 7.5 厘米浸润性尿道肌浸润性腺癌(pT2b)。手术切缘为阴性:单孔机器人辅助膀胱部分切除术治疗膀胱腺癌是安全的,其肿瘤治疗效果与微创和开放技术的标准治疗效果相当。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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