臍尿管癌使用機器人手臂輔助部分膀胱切除及臍尿管全切除：病例報告
吳子翔1、林宜佳 1,2、蔡德甫1,2、莊光達1,2、鄭以弘、仇光宇1,2、陳宏恩、何肇晏、葉志胤、
朱懿柏、黃一勝 1,2,3
新光吳火獅紀念醫院泌尿科1; 天主教輔仁大學醫學系泌尿科2; 台北醫學大學泌尿科3
Robot-assisted partial cystectomy and umbilectomy for urachal adenocarcinoma : case report
Tzu-Hsiang Wu1, Yi-Chia Lin1,2, Te-Fu Tsai1,2, Kuang-Dear Juang1,2, Yi-Hong Cheng, Kuang-Yu Chou1,2, Hong-En Chen, Chao-Yen Ho, Chih-Yin Yeh, Yi-Bo Chu and Thomas I.S. Hwang1,2,3
1 Division of Urology, Department of Surgery, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan;
2 Department of Urology, Fu Jen Catholic University School of Medicine, Taipei, Taiwan, ROC;
3 Department of Urology, Taipei Medical University, Taipei, Taiwan
Urachal cancer is a rare non-urothelial malignancy frequently involving the midline or dome of the bladder due to direct extension from the urachal ligament, the structure from which this tumor arises. Surgical intervention, a partial or radical cystectomy with en-bloc resection of the urachal ligament with the bladder dome and umbilicus, was required for cancer control. However, the sequence of cystectomy and umbilectomy was not in consensus. We tried to perform the umbilectomy first, and closed the wound as the camera port, then performed the partial cystectomy in order to decrease the wounds.
A 34 year-old female who has no previous systemic disease history suffered from gross hematuria for 2 weeks, and was found one 3-cm anterior pelvic tumor with urinary bladder dome invasion. The cystoscopic biopsy showed adenocarcinoma, and urachal adenocarcinoma was impressed. Robot- assisted partial cystectomy and umbilectomy plus lymph node dissection was arranged. Umbilectomy was done first, and the wound was used as camera port for robot docking. Another 3 ports for robot arm and one assistant port was place. The operation was done smoothly with total 5 operation wounds, including one new umbilicus made by plastic surgeon.
The histopathology revealed urachal adenocarcinoma, Sheldon stage IIIa. All margins were free and no lymph node metastasis was found. The patient was discharged at POD 10, and regular OPD follow-up was arranged.
Urachal carcinoma is a rare disease in urinary bladder, and the conventional port docking for robot system was 4 ports plus one assistant port, and additional large wound for umbilectomy was needed. We try to decrease the number of wounds, and to improve the cosmetic result by merging the umbilectomy wound with camera port. Long-term follow-up is still mandatory.