Robot-Assisted Laparoscopic Partial Cystectomy and Bladder Repair for Urachal Cyst, Suspected of Urachal Tumor

Yao-Chi ChuangTaiwan Moderator Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan. Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments. There are some Tips on what to do about what research is and how to get into it: 1. Ask a good question from your daily practice, what is unmet medical need? 2. Search the old literature of your research interests- what is known? What is unknown? 3. Find a new method to solve your question or an old method but applying to a new field. 4. Start from jointing a pre-planned research project, and join a research collaborative. 5. Try to be an independent researcher from a small project without funding support, retrospective study. 6. Try to get funding support from your institute, national grant, or industry. As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research

Masahiro KurobeJapan Speaker Robot-Assisted Laparoscopic Partial Cystectomy and Bladder Repair for Urachal Cyst, Suspected of Urachal TumorBackground: Urachal cyst is a type of congenital anomaly that may undergo malignant transformation. Partial cystectomy with en-block resection of the urachus is appropriate treatment for urachal remnants. We performed near infrared ray-guided surgery (NIRGS) for the accurate localization of tumor margins using the Firefly® technology of the daVinci Surgical system and intra-operative cystoscopy. In the normal visible light mode, we could not recognize the cystoscopic light; however, after changing to the Firefly® mode, the near infrared rays transmitted through the bladder wall were visible as a green image. Methods: The patient is a 76-year-old woman. She was referred to urology for a tumor at the dome of the bladder. Cystoscopy revealed a round submucosal mass at the dome of the bladder. The possibility of urachal tumor could not be excluded. Since she was already diagnosed with rectal cancer and scheduled to undergo robot-assisted laparoscopic proctosigmoidectomy, we performed robot-assisted partial cystectomy during the same operative session. Results: The rectum was removed by a surgeon with robot-assistance. Then we detached the median umbilical cord from just below the umbilicus toward the bladder. Both medial umbilical ligaments were dissected from abdominal wall to the dome of the bladder. A simultaneous cystoscopic light depicted the bladder boundaries of the mass with the Firefly® mode. The bladder mucosa was repaired with a 3-0 V-Loc® followed by a second 2-0 V-Loc® on the muscle and peritoneum. There was no residual tumor at the resected margin, and pathological findings revealed that the urachal cyst was benign. Her urinary catheter was removed on day 14. At the four month follow up, the patient was voiding well. Surveillance cystograms showed a well-healed bladder at eight month follow up. She has remained symptom free over the past 18 months since surgery. Conclusions: Robot-assisted laparoscopic partial cystectomy is technically feasible. Near infrared ray-guided technology plays a major role in obtaining accurate resection lines.