Robot-assisted laparoscopic bladder diverticulectomy in a seven-year-old child: Case report and points of technique
A seven-year-old male child was brought to us with complaints of lower abdominal pain while voiding for one year and one episode of terminal haematuria six months back. He did not have any difficulty in micturition or constipation. Physical examination was normal. Ultrasonogram revealed a bladder diverticulum arising from left posterolateral wall. Micturiting cystourethrogram (MCUG) confirmed the large bladder diverticulum and showed no abnormality in urethra or vesicoureteric reflux [].\nInitially, cystoscopy was performed and a double J stent was placed in the left ureter for intra-operative identification [Figures and ]. A 12 Fr Foley catheter was placed over a guide wire inside the diverticulum to help in later identification and dissection of the diverticulum. A 14 Fr Malecot catheter was placed suprapubically to drain the bladder. The patient was placed in the lithotomy position with Trendelenburg tilt. A 12-mm robotic camera port was placed just superior to the umbilicus. Two pediatric 5-mm ports for robotic arms were placed inferolaterally about 8 cm from the midline. An additional 5-mm assistant port was placed lateral to the left port. The robot was docked and the movement of the inflated Foley catheter bulb was used to identify the site of diverticulum. The left ureter and vas deferens were dissected away from the diverticulum. Methylene blue was injected into the diverticulum to delineate its extent [].The diverticulum was dissected all around till the neck was reached and it was excised at the neck level []. Detrusor muscle layer was closed in single layer using 3-0 vicryl [Figure and ]. Reperitonealization was performed over a drain []. The Foley catheter placed perurethrally was removed at the end of the procedure. The operating time was 65 minutes. The patient had an uneventful post-operative recovery. The suprapubic catheter was removed on fifth post-operative day. At 10 months follow-up the child was doing well with no urinary complaints [].