Laparoscopic vs robotic-assisted surgery for treating urachal anomalies in pediatric patients

PURPOSE: To report a multicenter experience with minimally invasive surgery (MIS) for pediatric urachal anomalies and to compare laparoscopic versus robotic-assisted approaches. METHODS: A retrospective review was performed of all patients with urachal remnants treated with MIS between January 2019 and January 2025. Demographic, perioperative, and outcome data were collected and analyzed. RESULTS: Twenty-three patients (13 males) with a median age of 5.9 years (range 6 months–14 years) underwent surgery for symptomatic urachal anomalies. Fifteen patients (65.2%) were treated laparoscopically and eight (34.8%) robotically. Complete excision was achieved in all cases. Median operative time was 45 min (range 33–73). A bladder catheter was maintained for 24 h postoperatively, and all patients were discharged within 48–72 h. Histopathology confirmed urachal remnants without evidence of malignancy. No intraoperative complications occurred. One minor postoperative complication (Clavien–Dindo I) was reported. Median follow-up was 2 years (range 5 months–6 years). CONCLUSION: MIS represents the gold standard for the treatment of urachal remnants. Both laparoscopy and robotic-assisted surgery are safe and effective. The robotic approach may offer ergonomic and technical advantages. Indocyanine green (ICG) fluorescence appears to facilitate lesion identification and guide dissection.