Laparoscopic en bloc partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma.

INTRODUCTION

Surgical options for treating urachal adenocarcinoma include radical cystectomy and en bloc partial cystectomy with excision of the urachus and umbilectomy. Recently, laparoscopy has been increasingly used to treat bladder and urachal pathologic findings efficaciously. We describe two techniques for performing laparoscopic en bloc partial cystectomy with bilateral extended pelvic lymphadenectomy.

TECHNICAL CONSIDERATIONS

We performed the procedure in 3 patients with established urachal adenocarcinoma. The anatomic boundaries of resection were similar to those described for open surgery. We used an inverted V-shaped, five-port configuration, with the camera port placed 3 cm supraumbilically. An antegrade approach was performed for tumors less than 5 cm in 2 cases. The steps of the procedure included an inverted V-shaped incision along the peritoneum lateral to the medial umbilical ligament on either side; urachal disconnection, dissection of the urachus using the "twist and roll technique"; anterior cystotomy, circumferential resection of the tumor-bearing bladder dome, under vision; tumor placement in a "lap-bag"; bladder reconstruction using intracorporeal suturing; bilateral extended pelvic lymphadenectomy; placement of catheter and drain; and specimen retrieval. We evolved a retrograde technique for larger size tumors (larger than 5 cm). The procedure was successfully completed in all patients, with a mean operative time of 180 minutes (range 150 to 210). No significant intraoperative or postoperative complications occurred, except for a left inferior epigastric artery injury in 1 case. The resected nodes (range 8 to 11) were free of tumor. No local or distant recurrences were observed at a mean follow-up of 6.5 months (range 4.5 to 9).

CONCLUSIONS

Laparoscopic en bloc partial cystectomy and bilateral extended pelvic lymphadenectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for urachal tumors.