Intraoperative imaging of indocyanine green with near infrared fluorescence is a safe and effective method to accurately identify the renal vasculature and to differentiate renal tumors from surrounding normal parenchyma. The capacity for multimodal imaging within the surgical console further facilitates this imaging. Further study is needed to determine if this technique will help improve outcomes of robotic assisted laparoscopic nephrectomy.

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OBJECTIVE To report the management of urachal anomalies using a robotically assisted approach. PATIENTS AND METHODS Between January 2005 and February 2006, five patients (mean age 51 years, range 24–68) were diagnosed with urachal anomalies. Two basic robot‐assisted surgical approaches were used for excising the urachal anomalies: excision of the urachal remnant via partial cystectomy, and radical cystectomy for excision of urachal adenocarcinoma. RESULTS All five cases were successful and the excised specimens were assessed histologically. The short‐term oncological outcome in the three patients with histologically confirmed moderately differentiated adenocarcinoma showed no evidence of recurrent disease within a median interval of 8 months. Surveillance follow‐up cystoscopy in the patients who had a partial cystectomy showed a well‐healed bladder mucosa with no evidence of recurrence. CONCLUSIONS Radical excision of the urachal tract with partial cystectomy or radical cystectomy using the da Vinci robot is safe, effective and technically feasible.

NIRF imaging after intravenous ICG administration may be a useful intraoperative imaging tool to differentiate malignant tumors from normal renal parenchyma during laparoscopic and robot-assisted partial nephrectomy. Advanced intraoperative imaging techniques such as this one may become increasingly helpful as more complicated tumors are resected with minimally invasive approaches.

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