Urachus is the embryological remnant of the allantois that connects the fetal bladder to the umbilicus. It usually obliterates in the 5th month of gestation, giving rise to the median umbilical ligament.

Several types of urachal anomalies have been described including urachal cyst, patent urachus, diverticulum, and sinus, of which urachal cysts is the most common anomaly, occuring in approximately 1/5,000 births. Urachal cysts are usually asymptomatic but may present as acute abdomen (secondary to infection), and become palpable.

We performed a light assisted mucosa sparing laparoscopic excision of a urachal cyst in a 24-year-old girl who presented with lower abdominal midline swelling. MR of the abdomen and pelvis revealed an anterior midline urachal cyst located just superior to the bladder that measured 6.2 x 4.5 cm. Management options of the urachal cyst were discussed with the patient and she was planned for laparoscopic excision.

On the table, cystoscopy and cystography were performed initially to identify any possible connection between the bladder and the urachal cyst. The patient was placed in the dorsal lithotomy and Trendelenberg position.

Peritoneal access was obtained using the open Hasson technique with placement of the 12-mm camera port in the midline using a vertical incision halfway between the umbilicus and the xiphoid process .

After creation of pneumoperitoneum, two additional ports (12 mm each) were inserted under direct vision at the anterior axillary lines just above the leve l of the umbilicus (one on each side).

Dissection began with lysis of the omental adhesions. After adhesiolysis, both the obliterated umbilical arteries were cauterized and divided to gain access to the anterior bladder wall. The urachal cyst was dissected from the anterior abdominal wall and mobilized all around, except at its attachment to the bladder, using a harmonic scalpal. The cystoscopy was carried out at this stage to visualize the demarcation between the cyst and the bladder wall with the help of a cystoscopic light. The bladder was kept partially distended to assist dissection between the bladder mucosa and cyst wall. Under cystoscopic light guidance, the cyst was dissected from the bladder wall without opening the bladder mucosa . The bladder was distended via the Foley catheter to ensure that there was no rent in bladder mucosa. The muscle defect was closed by running a 3-0 vicryl suture. The cyst was decompressed after taking it in an endobag and delivered from camera port. The Foley catheter was kept indwelling for 24 hours.

Histopathological examination of the cyst confirmed the presence of a benign urachal cyst with chronic inflammatiory changes.

Urachal cyst is an uncommon urachal anomaly having delayed presentation due to non specific signs and symptoms. Complete excision of the cyst is the treatment of choice.

Laparoscopic excision is increasingly being used with results comparable to open surgery with the advantages of a minimally invasive approach. Light guided mucosa sparing laparoscopic cyst excision is a novel technique which, in addition to being minimally invasive, will also reduce the complications associated with opening of bladder mucosa such as urinary leakage and bleeding, as well as having a shorter catheter time.