The Jikei University School of Medicine urology department

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Urology disease

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Laparoscopic urachus enucleation

1.About purpose

Urachus is canal to tie navel and bladder which usually exist for fetus to, but resolves with growth. However, abscess, cyst or malignant tumor may occur to persistent urachus. (figure 1)

With figure 1 urachus

 About difference in figure 2 wound

When size is big, urachus enucleation is necessary for cases to doubt tumor when it is accompanied by symptom or as radical cure treatment. Urachus enucleation usually performs an operation for median section wounds from navel to the top of pubic bones and exfoliates urachus from navel to the top of bladder and extracts. (figure 2)
 Patients with urachus disease have many relatively young patients, and the often wound may become mental stress. The cause of such a background, laparoscopic urachus enucleation came to be performed.
Laparoscopic urachus enucleation is only 3-4 places of small faults, and operation is possible and can operate without leaving big wound.
It enforces this method in March, 2014 in this hospital.
In addition, from September, 2016, we perform laparoscopic surgery (operation that Reduced port surgery reduced number of wound to) operating for wound only for two places of wound of the right lower quadrant and umbilical wound. We are operated on from two places of wounds like figure 2. Only wound of the right lower quadrant remains to navel to form again, but, as for this wound, postoperative wound is not outstanding because it is to underwear in part to hide in. In this hospital, we start this operation in March, 2014 and enforce 61 operations by June, 2017.

2.Adaptation

It is patient with urachus disease (urachus cyst, urachus abscess, urachus malignant tumor) that we judged to need operation. In patients with urachus abscess, there is not the need operated on by all means, but, also, may operate for the future recurrence prevention when we repeat inflammation when there are smell and sense of incongruity. Please consult about adaptation with the well foreign chief physician.
・Others

3.About method

We are operated on under the laparoscope for urachus disease.
At first we empty 2-3 places of small holes into the abdominal wall like figure 2 and insert cylindrical appliance (fatty car). We inject carbon dioxide (CO2) and we puff out stomach and make space of operation and we insert camera, forceps than fatty tuna car and operate. Urachus is canal to tie the top and navel of bladder to.

At first we perform identification, transection of urachus on the bladder top and turn and push forward the detachment to navel. We cut with umbilical part and put urachus in the exclusive bag and extract. When we perform complication ablation of navel, we extract urachus with navel. When part of bladder is thrown open, we sew up under the laparoscope and are closed down. We detain drain, urethral catheters, and operation becomes the end. Outpatient responds parallel to principle, plastic surgery about the umbilical rebuilding, management.


About difference in figure 2 wound

4.About expected complications

General complications of laparoscopic surgery include bleeding and the organ damage and hemostasis, laparotomy measures for damage restoration. It is necessary for enough experienced doctors to perform these operations with extreme caution to prevent these.
Operation that received specialist in urinary organ endoscope society authorization and in-hospital laparoscopic surgery authorization in this hospital Person is in charge of operation. We are operated on with caution enough safely.
Expected main complications are as follows. Please consult with the charge chief physician about complications being careful casually.
Main complications that are expected

●Fever, infectious disease

We give instillation of antibiotics before and after operation for the purpose of the infectious disease prevention. However, injury after operation infection, intraabdominal infection, urinary tract infection may occur. At this chance the dosage of antibiotics and extension of length of stay may be necessary. Risk to wake up infection of wound becomes in particular higher a little because there is already infection in urachus in the case of urachus abscess extraction. When wound infection develops, measures such as wound washing, re-suture may be necessary.

●Bleeding

Some bleeding may be caused after in operation or the operation. We may perform hemostasis measures and reoperation by vascular catheter operation when we detect sustained bleeding after the operation. In addition, we may transfuse after the perioperative operation when amount of bleeding is beyond constant degree.

●Pulmonary vein thrombosis

By perioperative or postoperative lying in bed, clot (gore) is possible in vein of lower limbs, and it comes off and moves, and blood vessel of the lungs may be clogged up. (pulmonary vein thrombosis), in this hospital, perform the precautionary measures based on operation pulmonary vein thrombosis guidelines. For the prevention, we have you wear elastic stockings after perioperative ... operation and promote as possible early getting up.
 But please do not perform by judgment of the patient as doctor performs judgment of getting up. We inject thromboprophylaxis after the operation again (under the influence of anesthetic agents, it sways, and this is because we may fall down.). We cope with specialized course by any chance when it develops in pulmonary vein thrombosis.

●The damage (intestinal tract, bladder, blood vessel) of neighboring organs

The damage may be caused by perioperative detachment operation at neighboring organs, organizations. Under normal operations, it is rare, but is at the risk when the adhesion with urachus and the abdominal wall fits intestinal tract with inflammation. When restoration under the laparoscope is difficult, it may shift to open surgery. In addition, we may ask each specialized surgical doctor for restoration as needed. In addition, when perioperative complications occur, we quit among laparoscopic surgery and may shift to open surgery. Open surgery does not have perioperative case that we changed in past 61 cases.

●Urinary flow appearance, ruptured suture from bladder

Urachus is connected to bladder and extracts urachus after having thrown part of bladder open depending on case. In this case bladder thrown open detains the suture closure, postoperative urethral catheters for approximately one week.
 It is extremely rare, but urine may leak after the operation from suture part. In this case we detain urethral catheters more for around 3-7 days. We are cured by conservative treatment such as the said article, but may almost reoperate when we do not accept improvement.

●Postoperative ileus (ileus)

Movement of the bowels may worsen under the influence of operation or anesthesia temporarily. In this case we suspend meal and examine course, but may perform measures to put thin pipe in stomach and the bowels from nose when we do not accept improvement. In many cases, we are improved conservatively.

Complications peculiar to laparoscopic surgery
●Subcutaneous emphysema

We inject carbon dioxide (CO2) in abdominal cavity, and laparoscopic surgery secures space and performs. Therefore carbon dioxide leaks subcutaneously, and skin may feel in petit petit state that we did after the operation. We call this subcutaneous emphysema, but there are not direct adverse effects to body and is usually relieved naturally.

●Projected pain to shoulder

We may feel pain falling out to shoulder on the second to the third day after surgery. With thing by stimulation of carbon dioxide which remained behind in abdominal cavity, it is relieved naturally.

●Hypercapnia

Carbon dioxide melts into in blood, and carbon dioxide concentration of blood is in condition to increase. We are improved by intraoperative breathing management and use of medicine, but may switch to open surgery when improvement is insufficient.

●Port site hernia

The bowels get into wound that we put postoperative camera and machine in and may cause ileus. We cut part of wound open conservatively when there is not improvement and may reoperate.

●Air embolus

Carbon dioxide gets in blood vessel, and embolic symptom is caused. It does not usually take place with a little gas. We are careful about pressure of intraoperative gas and are operated on.

5.Other general cures

As a general rule, radical cure treatment of urachus disease becomes operation. Laparoscopic surgery and open surgery have insurance adaptation.

6.About protection of human rights, privacy

As for the personal information of patient using in this treatment, "official regulations about educational foundation Jikei The Jikei University personal information protection" observe associated detailed rules and handle with work, scrupulous attention for protection. Result of treatment may be announced by society or medical article, but don't worry as it is not determined as for the full name of patient that substitution, thing about privacy leak in initial or sign outside.

7.About expense

Laparoscopic urachus extirpation became insurance adaptation from April, 2014.

We feel free to contact if you have any questions, and please consult.
Please call urology department outpatient from representative (03-3433-1111).
Charge supervisory manager: Hiroshi Sasaki (bamboo grass comes Hiroshi) 

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