單孔機械手臂輔助腹腔鏡異物臍尿管腫瘤切除手術
劉瑞文、江怡德、高偉棠
衛生福利部立雙和醫院 泌尿科
Foreign body granuloma mimics urachal tumor:
single site robotic assisted partial cystectomy
Liu Jui wen, Chiang Yi Te, Kao Wei Tang
Department of Urology, Shuang Ho hospital, Taipei Medical University, Taipei, Taiwan
Introduction: Foreign body granuloma can mimic malignancies especially in urachal tumor. After literature review, urachal granuloma induced by hernia mesh is rarely reported. We present the clinical presentations, management and pathologic results of one urachal tumor patient and discuss the pro and con of single site robotic approaching.
Case report:This 73 years old male patient has history of hypertension under medication control and right open mesh-repair herniorrhaphy 3 years ago. This time he suffered from right lower quadrant of abdominal pain with microscopic hematuria for 2 months. Initially he went to ShengKun hospital for help. CT scan showed irregular and heterogeneous enhancing mass about 5cm over bladder dome with involving the posterior wall of the right inguinal canal. Tentative diagnosis was urachal cancer. He came to our hospital for second opinion. Physical examination showed right lower quadrant of abdominal tenderness. Blood tests showed normal results and urine cytology was negative for malignancy. TUR-BT was arranged on 2018.8.15 and pathology revealed chronic cystitis. However, his symptom got worsen and follow-up CT revealed similar result. Therefore, we performed single site robotic assisted laparoscopic urachal tumor excision and partial cystectomy on 2018.9.19 without complication. Post-OP cystography showed no leakage and the patient was discharged under stable condition. Final pathological report showed chronic inflammation with multiple foci of foreign body granuloma.
Discussion: Urachus is formed in embryonic life and then becomes the median umbilical ligament during early infant. Urachal tumor arises from urachus remnant and often located at bladder dome with extending into prevesical space. Clinical symptoms are hematuria, lower abdominal palpable mass or pain and sometimes mucusuria. Primary management is en bloc resection. The role of radiotherapy or chemotherapy is unclear in locally advanced or metastatic group.
Most cases of foreign body granuloma were diagnosed by pathology. Foreign body resource may be from remnant suture, prosthesis, mesh or implant. Patients have good prognosis after operation.
Laparoscopic removal of urachal tumor with or without umbilicus excision was performed increasing in the minimal-invasive era. There were also several reports about single-port laparoscopic urachal tumor excision or by robotic-assisted laparoscopic trend. However, using single site robotic assisted approach for treating urachal tumor was not noted when we searched literature. The reason may be due to easy collisions of previous type Da Vinci machines when operations done by single site approach. We used a Glove Port (Nelis, Gyeonggi-do, Korea) to maximum working space with a 30 degrees scope upward. This settings could decrease the opportunity of collision and easily for assistant to manipulate instruments. Operation time for this case is longer (287 minutes, blood loss:50ml, admission: 7days) but the patient recovered smoothly. Therefore, we think single site robotic assistant partial cystectomy is a feasible approach for urachal tumor resection.