Vaginal urethral diverticulectomy can be challenging, particularly for circumferential and dorsal diverticula. With the increasing adoption of robotic surgery, access to the pelvis has improved, providing better visualization for both the surgeon and the assistant. The objective of this video is to describe a robotic approach to urethral diverticulectomy using the Medtronic HUGO robot.

Two female patients, aged 29 and 67, were treated. The first patient presented with chronic pain and recurrent urinary tract infections over several years, with no significant medical history. MRI revealed a circumferential urethral diverticulum. The second patient, aged 67, had a history of TOT sling placement and promontofixation and consulted for pain and urinary infections. MRI identified a right lateral urethral diverticulum.

The procedure was performed under general anesthesia using the Medtronic HUGO robot via a transperitoneal approach. The Retzius space was dissected down to the bladder neck. During periurethral dissection, both diverticula were clearly identified, dissected, and resected. A cystoscopy was performed intraoperatively to locate the urethra. A methylene blue test was used to visualize the ostium, which was then sutured. The second patient's diverticulum was a blind pouch, requiring suturing along the lateral aspect of the urethra.

Robotic-assisted laparoscopic urethral diverticulectomy offers a precise surgical approach compared to the perineal route.