Minimally Invasive LESS for Urachal Remnant

  • Fuminori SatoEmail author
  • Toshitaka Shin
  • Kenichi Hirai
  • Tadasuke Ando
  • Takeo Nomura
  • Toshiro Terachi
  • Hiromitsu Mimata


Urachal remnant is the persistence of an embryonic tubular structure that connects the urinary bladder to the allantois. Recent reports suggest that an asymptomatic urachal remnant in children does not require surgical treatment. Children with repeated infection of the urachal remnant, as well as adults with symptomatic urachal abnormalities, should undergo surgical resection. For resecting an urachal remnant, laparoendoscopic single-site surgery via single umbilical incision can provide a better cosmetic outcome compared with conventional multiport laparoscopy. Similar to conventional laparoscopy or open surgery, the umbilical laparoendoscopic single-site surgery should be planned after sufficient management of any preceding infection. Both para- and intraumbilical 2-cm incisions are used for commencing the dissection of the urachal remnant. The proximal part of the urachal remnant should be dissected as far distally as possible with an open surgical procedure, because this part is too close to dissect via the umbilical access site with laparoscopic technique. Using a small single-site platform with three 5-mm ports, an effective counter traction and sharp dissection of the urachal remnant can be performed. To close the bladder wall, horizontal stitching with 2-0 absorbable sutures is recommended. The incised anterior peritoneum is closed with a 3-0 running suture. The umbilical laparoendoscopic single-site surgery is a simple and efficient minimally invasive technique and appears to be ideal for patients with symptomatic urachal remnant.


Laparoendoscopic single site surgery Urachal remnant Laparoscopy 


Disclosure Statement

No competing financial interests exist.


  1. Ahmed K, Wang TT, Patel VM, Nagpal K, Clark J, Ali M, Deeba S, Ashrafian H, Darzi A, Athanasiou T, Paraskeva P. The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc. 2011;25:378–96.CrossRefGoogle Scholar
  2. Araki M, Saika T, Araki D, Kobayashi Y, Uehara S, Watanabe T, Yamada K, Nasu Y, Kumon H. Laparoscopic management of complicated urachal remnants in adults. World J Urol. 2012;30:647–50.CrossRefGoogle Scholar
  3. Ashley RA, Inman BA, Routh JC, Rohlinger AL, Husmann DA, Kramer SA. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol. 2007;178:1615–8.CrossRefGoogle Scholar
  4. Aull MJ, Afaneh C, Charlton M, Serur D, Douglas M, Christos PJ, Kapur S, Del Pizzo JJ. A randomized, prospective, parallel group study of laparoscopic versus laparoendoscopic single site donor nephrectomy for kidney donation. Am J Transplant. 2014;14:1630–7.CrossRefGoogle Scholar
  5. Autorino R, Brandao LF, Sankari B, Zargar H, Laydner H, Akça O, De Sio M, Mirone V, Chueh SC, Kaouk JH. Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis. BJU Int. 2015;115:206–15.CrossRefGoogle Scholar
  6. Blichert-Toft M, Nielsen OV. Diseases of the urachus simulating intra-abdominal disorders. Am J Surg. 1971;122:123–8.CrossRefGoogle Scholar
  7. Blichert-Toft M, Koch F, Nielsen OV. Anatomic variants of the urachus related to clinical appearance and surgical treatment of urachal lesions. Surg Gynecol Obstet. 1973;137:51–4.PubMedGoogle Scholar
  8. Cacciarelli AA, Kass EJ, Yang SS. Urachal remnants: sonographic demonstration in children. Radiology. 1990;174:473–5.CrossRefGoogle Scholar
  9. Cadeddu JA, Boyle KE, Fabrizio MD, Schulam PG, Kavoussi LR. Laparoscopic management of urachal cysts in adulthood. J Urol. 2000;164:1526–8.CrossRefGoogle Scholar
  10. Cutting CW, Hindley RG, Poulsen J. Laparoscopic management of complicated urachal remnants. BJU Int. 2005;96:1417–21.CrossRefGoogle Scholar
  11. Fan X, Lin T, Xu K, Yin Z, Huang H, Dong W, Huang J. Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol. 2012;62:601–12.CrossRefGoogle Scholar
  12. Galati V, Donovan B, Ramji F, Campbell J, Kropp BP, Frimberger D. Management of urachal remnants in early childhood. J Urol. 2008;180:1824–6.CrossRefGoogle Scholar
  13. Garisto JD, Henriquez K, Pimentel MEE. Single-incision laparoscopy surgery excision of an infected urachal cyst: description of the technique. J Endourol Case Rep. 2017;3:7–9.CrossRefGoogle Scholar
  14. Gill IS, Canes D, Aron M, Haber GP, Goldfarb DA, Flechner S, Desai MR, Kaouk JH, Desai MM. Single port transumbilical (E-NOTES) donor nephrectomy. J Urol. 2008;180:637–41.CrossRefGoogle Scholar
  15. Gleason JM, Bowlin PR, Bagli DJ, Lorenzo AJ, Hassouna T, Koyle MA, Farhat WA. A comprehensive review of pediatric urachal anomalies and predictive analysis for adulturachal adenocarcinoma. J Urol. 2015;193:632–6.CrossRefGoogle Scholar
  16. Hirano D, Minei S, Yamaguchi K, Yoshikawa T, Hachiya T, Yoshida T, Ishida H, Takimoto Y, Saitoh T, Kiyotaki S, Okada K. Retroperitoneoscopic adrenalectomy for adrenal tumors via a single large port. J Endourol. 2005;19:788–92.CrossRefGoogle Scholar
  17. Hu Q, Gou Y, Sun C, Xu K, Xia G, Ding Q. A systematic review and meta- analysis of current evidence comparing laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy. J Endourol. 2013;27:676–83.CrossRefGoogle Scholar
  18. Humphrey JE, Canes D. Transumbilical laparoendoscopic single-site surgery in urology. Int J Urol. 2012;19:416–28.CrossRefGoogle Scholar
  19. Iida T, Kawa G, Takizawa N, Kawabata T, Komai Y, Kinoshita H, Matsuda T. Laparoendoscopic single-site surgery for urachal remnants. Asian J Endosc Surg. 2012;5:100–2.CrossRefGoogle Scholar
  20. Kilday PS, Finley DS. Robot-assisted excision of a urachal cyst causing dyspareunia and dysorgasmia: report of a case. J Endourol Case Rep. 2016;2:3–5.PubMedPubMedCentralGoogle Scholar
  21. Kim DK, Lee JW, Park SY, Kim YT, Park HY, Lee TY. Initial experience with robotic-assisted laparoscopic partial cystectomy in urachaldiseases. Korean J Urol. 2010;51:318–22.CrossRefGoogle Scholar
  22. Kojima Y, Hayashi Y, Yasui T, Itoh Y, Maruyama T, Kohri K. Laparoscopic management for urachal cyst in a 9-year-old boy. Int Urol Nephrol. 2007;39:771–4.CrossRefGoogle Scholar
  23. Kurien A, Rajapurkar S, Sinha L, Mishra S, Ganpule A, Muthu V, Sabnis R, Desai M. First prize: standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol. 2011;25:365–70.CrossRefGoogle Scholar
  24. Lee SW, Lee JY, Kim KH, Ha US. Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation in men with palpable varicocele: a randomized, clinical study. Surg Endosc. 2012;26:1056–62.CrossRefGoogle Scholar
  25. Li Destri G, Schillaci D, Latino R, Castaing M, Scilletta B, Cataldo AD. The urachal pathology with umbilical manifestation: overview of laparoscopic technique. J Laparoendosc Adv Surg Tech A. 2011;21:809–14.CrossRefGoogle Scholar
  26. Lipskar AM, Glick RD, Rosen NG, Layliev J, Hong AR, Dolgin SE, Soffer SZ. Nonoperative management of symptomatic urachal anomalies. J Pediatr Surg. 2010;45:1016–9.CrossRefGoogle Scholar
  27. Matsuda T. Recent advances in urologic laparoscopic surgeries: laparoendoscopic single-site surgery, natural orifice transluminal endoscopic surgery, robotics and navigation. Asian J Endosc Surg. 2013;6:68–77.CrossRefGoogle Scholar
  28. McCollum MO, Macneily AE, Blair GK. Surgical implications of urachal remnants: presentation and management. J Pediatr Surg. 2003;38:798–803.CrossRefGoogle Scholar
  29. Minevich E, Wacksman J, Lewis AG, Bukowski TP, Sheldon CA. The infected urachal cyst: primary excision versus a staged approach. J Urol. 1997;157:1869–72.CrossRefGoogle Scholar
  30. Naiditch JA, Radhakrishnan J, Chin AC. Current diagnosis and management of urachal remnants. J Pediatr Surg. 2013;48:2148–52.CrossRefGoogle Scholar
  31. Nakamura H, Oshita A, Imamura Y, Sasaki M, Kohyama M, Tazaki T, Sugiyama Y, Daimaru Y, Nakamitsu A. Successful treatment of a patient with an infected urachal remnant via single-incisionlaparoscopic surgery: report of a case. Asian J Endosc Surg. 2016;9:86–8.CrossRefGoogle Scholar
  32. Neufang T, Ludtke FE, Lepsien G. Laparoscopic excision of an urachal fistula—a new therapy for a rare disorder. Min Invasive Ther. 1992;1:245–9.Google Scholar
  33. Nogueras-Ocaña M, Rodríguez-Belmonte R, Uberos-Fernández J, Jiménez-Pacheco A, Merino-Salas S, Zuluaga-Gómez A. Urachal anomalies in children: surgical or conservative treatment? J Pediatr Urol. 2014;10:522–6.CrossRefGoogle Scholar
  34. Nozaki T, Ichimatsu K, Ito T, Yasuda K, Watanabe A, Fuse H. Laparoscopic excision of symptomatic urachal anomalies: a technique to restore the natural appearance of the umbilicus. J Laparoendosc Adv Surg Tech A. 2010;20:821–4.CrossRefGoogle Scholar
  35. Okegawa T, Odagane A, Nutahara K, Higashihara E. Laparoscopic management of urachal remnants in adulthood. Int J Urol. 2006;13:1466–9.CrossRefGoogle Scholar
  36. Ozbek SS, Pourbagher MA, Pourbagher A. Urachal remnants in asymptomatic children: gray-scale and color Doppler sonographic findings. J Clin Ultrasound. 2001;29:218–22.CrossRefGoogle Scholar
  37. Patrzyk M, Glitsch A, Schreiber A, von Bernstorff W, Hei- decke CD. Single-incision laparoscopic surgery as an option for the laparoscopic resection of an urachal fistula: First description of the surgical technique. Surg Endosc. 2010;24:2339–42.CrossRefGoogle Scholar
  38. Patrzyk M, Wilhelm L, Ludwig K, Heidecke CD, von Bernstorff W. Improved laparoscopic treatment of symptomatic urachal anomalies. World J Urol. 2013;31:1475–81.CrossRefGoogle Scholar
  39. Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology. 2007;70:1039–42.CrossRefGoogle Scholar
  40. Rane A, Rao P, Rao P. Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology. 2008;72:260–3.CrossRefGoogle Scholar
  41. Richstone L, Rais-Bahrami S, Waingankar N, Hillelsohn JH, Andonian S, Schwartz MJ, Kavoussi LR. Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrecomy: a prospective randomized controlled trial. BJU Int. 2013;112:616–22.CrossRefGoogle Scholar
  42. Robert Y, Hennequin-Delerue C, Chaillet D, Dubrulle F, Biserte J, Lemaitre L. Urachal remnants: sonographic assessment. J Clin Ultrasound. 1996;24:339–44.CrossRefGoogle Scholar
  43. Sato F, Shin T, Yuki H, Liang M, Ando T, Mori K, Nomura T, Mimata H. Umbilical laparoendoscopic single-site technique for complete excision of urachal remnant. J Laparoendosc Adv Surg Tech A. 2012;22:899–903.CrossRefGoogle Scholar
  44. Sato H, Furuta S, Tsuji S, Kawase H, Kitagawa H. The current strategy for urachal remnants. Pediatr Surg Int. 2015;31:581–7.CrossRefGoogle Scholar
  45. Sato F, Nakagawa K, Kawauchi A, Matsubara A, Okegawa T, Habuchi T, Yoshimura K, Hoshi A, Kinoshita H, Miyajima A, Naitoh Y, Inoue S, Itaya N, Narita S, Hanai K, Okubo K, Yanishi M, Matsuda T, Terachi T, Mimata H. Laparoendoscopic single-site surgeries: a multicenter experience of 469 cases in Japan. Int J Urol. 2017;24:69–74.CrossRefGoogle Scholar
  46. Schubert GE, Pavkovic MB, Bethke-Bedürftig BA. Tubular urachal remnants in adult bladders. J Urol. 1982;127:40–2.CrossRefGoogle Scholar
  47. Stopak JK, Azarow KS, Abdessalam SF, Raynor SC, Perry DA, Cusick RA. Trends in surgical management of urachal anomalies. J Pediatr Surg. 2015;50:1334–7.CrossRefGoogle Scholar
  48. Trondsen E, Reiertsen O, Rosseland AR. Laparoscopic excision of urachal sinus. Eur J Surg. 1993;159:127–8.PubMedGoogle Scholar
  49. Tugcu V, Ilbey YO, Mutlu B, Tasci AI. Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol. 2010;24:1315–20.CrossRefGoogle Scholar
  50. Tugcu V, Ilbey YO, Sonmezay E, Aras B, Tasci AI. Laparoendoscopic single-site versus conventional transperitoneal laparoscopic pyeloplasty: a prospective randomized study. Int J Urol. 2013;20:1112–7.CrossRefGoogle Scholar
  51. Turial S, Hueckstaedt T, Schier F, Fahlenkamp D. Laparoscopic treatment of urachal remnants in children. J Urol. 2007;177:1864–6.CrossRefGoogle Scholar
  52. Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H. Urachal anomalies: ultrasonography and management. J Pediatr Surg. 2003;38:1203–7.CrossRefGoogle Scholar
  53. Wang J, Xue B, Shan YX, Cui Y, Tao W, Zhu J, Liu X, Yao Q. Laparoendoscopic single-site surgery with a single channel versus conventional laparoscopic varicocele ligation: a prospective randomized study. J Endourol. 2014;28:159–64.CrossRefGoogle Scholar
  54. Yamzon J, Kokorowski P, De Filippo RE, Chang AY, Hardy BE, Koh CJ. Pediatric robot-assisted laparoscopic excision of urachal cyst and bladder cuff. J Endourol. 2008;22:2385–8.CrossRefGoogle Scholar
  55. Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 2001;21:451–61.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Fuminori Sato
    • 1
    Email author
  • Toshitaka Shin
    • 1
  • Kenichi Hirai
    • 1
  • Tadasuke Ando
    • 1
  • Takeo Nomura
    • 1
  • Toshiro Terachi
    • 1
  • Hiromitsu Mimata
    • 1
  1. 1.Department of Urology, Faculty of MedicineOita UniversityYufuJapan

Personalised recommendations