達文西機械手臂輔助腹腔鏡臍尿管腫瘤切除病例報告
洪巨軒、王彥傑
國泰綜合醫院 外科部 泌尿外科
Roboitc-assisted laparoscopic urachal tumor en-bloc resection
Chu-Hsuan Hung, Yen-Chieh Wang
Division of Urology, Department of Surgery, Cathay General Hospital
Abstract: Urachus is a remnant structure of embryonic period that connects the allantois to the fetal bladder. Urachal cancer is a rare disease so we have no absolute guideline for complete treatment until now.
We report a case of a 38 year-old man presenting with intermittent gross hematuria for one year. Initilally, he visited our hospital for gross hematuria. He refused cystoscopy and lost of follow up after symptoms improved. However, gross hematuria attacked again one year later. This time, the symptom persisted for one month. Thus, he visited our hospital again and received further evaluation. Intravenous pyelography (IVP) revealed bladder filling defect. Cystoscopy revealed broad-base bladder tumor with nrecotic surface at posterior wall. He was then admitted for transurethral resection of bladder tumor (TURBT).
TURBT was performed smoothly. Computed tomography (CT) showed urachal tumor with bladder invasion. The pathology report subsequently showed high-grade mucinous adenocarcinoma. Urachal carcinoma with bladder invasion was the final diagnosis. After discussion with the patient, he received robotic-assisted laparoscopic urachal tumor en-bloc resection two weeks later.
The surgery was performed smoothly. The urachal tumor was en-bloc resected, besides bilateral pelvic lymph node and partial cystectomy were also carried out. We sent five piece of bladder margin for frozen section intraoperative and the result were all negative. The pathology report revealed mucinous adenocarcinoma, originate from urachus with extension to urinary bladder. Focal peritoneum was perforated by tumor. The pelvic lymph node were no evidence of metastasis (0/8). The stage in Shledon system is stage 3. We consulted oncologist for adjuvant therapy. Chemotherapy with mFOLFOX6 for seven cycles was applied until now. We will keep follow up for his condition.
Conclusion: Robotic surgery could provide minimal-invasive technique, wild operative filed, and accurate resection. It is an ideal approach for surgery of urachal carcinoma.