Robotic retroperitoneal lymphadenectomy in paratesticular rhabdomyosarcoma

Yesica Y. Quiroz ¹ , Enver Moncada ² , Erika Llorens ³ , Ivan Schwartzmann ⁴ , Jorge Caffarati ⁵ , Anna Bujons ^*

Summary

Introduction

Paratesticular sarcoma is an aggressive malignant tumor of mesenchymal origin. The rhabdo-myosarcoma is the most common among children. Rhabdomyosarcoma treatment consists of surgery, chemotherapy and radiotherapy. Prognosic depends on local recurrence and distant  metastasis.

Material and methods

We present the case of a 16-year-old male, who in April 2016 underwent right radical orchiectomy surgery by testicular mass rapidly evolving, with pathological results indicating a paratesticular rhabdomyosarcoma. The extension study showed a precaval adenopathy suggestive of lymph node metastasis, therefore it was a high-grade rhabdomyosarcoma. There was an appropriate response after chemotherapy (Protocol EpSSG RMS2005) and we decided to perform a robotic.

Results

We performed a transperitoneal approach with 8 mm trocar and 12 mm optica trocar. We accessed the retroperitoneal space through a latero-colic incision. Then we performed a craniocaudal lymph node dissection until the aortic bifurcation. The surgical time was 240 min with a blood loss of 200 ml. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of rhabdomyosarcoma without capsular rupture. After two months, we placed the left testicle into inguinal canal prior to radiotherapy.

Conclusions

Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.

Robotic-assisted laparoscopic repair of a congenital rectourethral fistula with duplicated urethra

Rohan G. Bhalla ^a , Belinda Li ^{b,d, *}, Mark C. Adams ^b , Wallace W. Neblett ^c , John C. Thomas ^b

Summary

Objective

To describe our experience with robot-assisted laparoscopic transperitoneal repair of a congenital rectourethral fistula in a pediatric patient with a urethral duplication.

Methods

The patient is a 2-year-old male with a past medical history of Tetralogy of Fallot presenting with a febrile urinary tract infection (UTI). He was diagnosed with urethral duplication and a rectourethral fistula by voiding cystourethrogram (VCUG). The parents were counseled on various options and agreed to proceed with a robotic repair.

Results

Robotic-assisted transperitoneal rectourethral fistula repair was performed. The procedure time was 229 min with an estimated blood loss (EBL) of 15 mL. His postoperative course was unremarkable. At his 2- week follow-up, the urethral catheter was removed and the patient was voiding normally and having normal bowel movements.

Conclusion

Congenital rectourethral fistula with urethral duplication is a rare anomaly with only a few reports in the literature. Pediatric robotic-assisted trans-peritoneal rectourethral fistula repair is a technically feasible approach in infants with minimal morbidity that allows for excellent visualization and avoids open repair.

Complete diphallia: How to proceed?

Antonio Macedo Jr ^a,b , Se´rgio Leite Ottoni ^b ,  Paula Cartaxo Barros Camilato ^b , Hugo Santiago Crespo Ganchozo ^b , Gilmar Garrone ^b , Ricardo de Mattos Marcondes ^b , Marcela Leal da Cruz ^{b, *}

Summary

Introduction

Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication.

Methods

We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder.

Results

The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base.

Discussion

Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency.

Conclusion

The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic.