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The urachus was identified between the two umbilical ligaments and was followed cranially to its end where it was dissected. It was carefully separated from the bladder identifying a tiny passage (Fig. 2). The urachus was extracted using an endobag and sent for definitive histological examination. To ensure a tight suture, the bladder was sutured with V-lock 3-0 stitch (Fig. 3) and the parietal peritoneum was closed (Fig. 4). Postoperative course was uneventful, oral feeding was started the Fig. 1 A T2-weighted image on MRI showed a urachal cyst in front of anterior wall of bladder (arrow) Fig. 2 The urachal cyst during robotic-assisted laparoscopic excision Arena et al. Annals of Pediatric Surgery (2021) 17:11 Page 2 of 5 day after the procedure, and the patient was discharged after 7 days. Histology confirmed a urachal cyst. Three months later, a follow-up ultrasound was normal. Discussion The sign and symptoms of urachal abnormalities range from a completely asymptomatic, incidentally found lesion to pain, infection, lower urinary tract symptoms, and rarely, malignant degeneration [1]. While the management of an asymptomatic urachal remnant is still controversial, surgical excision of a symptomatic lesion is strongly recommended. Even if open surgery has been deemed the mainstay for many years, minimal invasive techniques have been employed being considered a safe, effective alternative with additional advantages of improved anatomical visualization and cosmesis [5, 6]. Robotic-assisted laparoscopy for the surgical management in pediatric age of urachal anomalies was firstly Fig. 3 Suture of bladder dome with V-lock stitch Fig. 4 Closure of anterior abdominal wall Arena et al. Annals of Pediatric Surgery (2021) 17:11 Page 3 of 5 described by Yamzon et al. [7]. Later, some case series of children who underwent robotic-assisted laparoscopic urachal cyst excision were reported [1, 8]. In front of longer operating times, including increased time for robotic setup, surgeon learning curve, and increased cost of robotic equipment, this technique offers the advantages of a 3-dimensional visualization, easier intracorporeal suturing and a more precise excision of the lesion compared to standard laparoscopy [9, 10]. In particular, in our case, the patient had undergone a previous laparoscopic appendectomy and robotic management was useful in carrying out a complete lysis of adherence. Recently, it has been highlighted that early laparoscopic procedures could trigger previously asymptomatic urachal remnants causing them to become symptomatic. Port site injuries to urachal remnants have been reported in nine other cases, two involving urachal cysts [11, 12], two a possible patent urachus [11, 13], and five cases related to a urachal diverticulum [14–18]. Our case resembles a third reported case of a possible patent urachus probably injured during port placement. A possible explanation could be that a lesion and contamination or insufflation of carbon oxide during placement of an umbilical or suprapubic port might have caused an enlargement of quiescent, asymptomatic urachal remnants [11]. Moreover, it is worth reflecting that even an emptied bladder, an iatrogenic lesion of an asymptomatic patent urachus or urachal diverticulum is susceptible to damage on insertion of a suprapubic port as the remnants are sited in the Retzius space [18]. evaluation: A pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment. Ann Otol Rhin Laryngol 107(2):120, 1998 5. Hassan SJ, Weymuller EA: Assessment of quality of life in head and neck cancer patients. Head Neck 15(6):485, 1993 6. Deleyiannis FW, Weymuller EA, Coltrera MD, Futran N: Quality of life after laryngectomy: Are functional disabilities important? Head Neck 21(4):319, 1999 7. Rosenfeld RM: Pilot study of outcomes in pediatric rhinosinusitis. Arch Otolaryngol Head Neck Surg 121:729, 1995 8. Piccirillo JF, Gates GA, White DL, Schectman KB: Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol Head Neck Surg 118(6):833, 1998 9. Isenberg SF, Rosenfeld The National Resident Matching Program® (NRMP®) is a private, not-for-profit corporation established in 1952 to optimize the rank-ordered choices of applicants and program directors for clinical training in the United States. The NRMP is not an application processing service; rather, it provides an impartial venue for matching applicants' and programs' preferences for each other using an internationally recognized mathematical algorithm. The first Main Residency Match® ("the Match") was conducted in 1952 when 10,400 internship positions were available for 6,000 graduating U.S. medical school seniors. By 1973, there were 19,000 positions for just over 10,000 graduating U.S. seniors. Following the demise of internships in 1975, the number of first-year post-graduate (PGY-1) positions declined to 15,700; however, the number of PGY-1 positions gradually increased through 1994 before declining slowly until 1998. Since that time, the number of PGY-1 positions has only increased. This year, an all-time high 35,194 PGY-1 positions were offered (Figure 1), the nineteenth consecutive annual increase. The total number of positions, at 38,106, also was an all-time high. The trend in the total number of applicants is more dramatic, rising from 6,000 in 1952 to 36,056 in 1999. After a decline of 5,052 applicants from 1999 to 2003, the number has risen each year since the 2004 Match. In 2021, the number of registrants reached an all-time high of 48,700, an increase of 3,741 over 2020. For more information about the NRMP, please visit: www.nrmp.org. Additional data and reports for the Main Residency Match and the Specialties Matching Service® (SMS®) are at: http://www.nrmp.org/main-residencymatch-data/ and http://www.nrmp.org/fellowship-matchdata/. Instructions on how to request NRMP data also are provided. Results and Data 2021 Main Residency Match® iv Definitions/Organizations ACGME Accreditation Council for Graduate Medical Education. Active Applicant An applicant who submits a certified rank order list of programs. All In Policy Any program registering for the Match must attempt to fill all positions through the Match or another national matching plan. Applicant Type The NRMP classifies applicants for the Main Residency Match into eight types: · A 4th-year medical student in a U.S. allopathic medical school accredited by the Liaison Committee on Medical Education (LCME) with a graduation date after July 1 in the year before the Match; also referred to as a U.S. MD senior. · A 4th-year medical student in a U.S. osteopathic medical school accredited by the Commission on Osteopathic College Accreditation (COCA) with a graduation date after July 1 in the year before the Match; also referred to as a U.S. DO senior. · Previous Graduate of U.S. MD Medical School (U.S. MD Grad): A graduate of a U.S. allopathic school of medicine accredited by the LCME with a graduation date before July 1 in the year before the Match. Previous U.S. graduates are not sponsored by their medical schools. · Previous Graduate of U.S. DO Medical School (U.S. DO Grad): A graduate of a U.S. osteopathic school of medicine accredited by the COCA with a graduation date before July 1 in the year before the Match. Previous U.S. DO graduates are not sponsored by their medical schools. · Student/Graduate of Canadian Medical School (Canadian): A senior student or graduate of a Canadian school of medicine accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS). · Graduate of Fifth Pathway Program (5th Pathway): A graduate of a U.S. Fifth Pathway program. · U.S. Citizen Student/Graduate of International Medical School (U.S. IMG): A U.S. citizen who attended an international medical school. · Non-U.S. Citizen Student/Graduate of International Medical School (Non-U.S. IMG): A non-U.S. citizen who attended an international medical school. In this report, applicant types are sometimes combined into a smaller number of groups. · Foreign-Trained Physicians: U.S. citizen and non-U.S. citizen students and graduates of international medical schools. · Others: Includes previous graduates of MD and DO, Canadian and Fifth Pathway applicants. Couple Any two applicants who register as a couple in the Match. The NRMP allows couples to form pairs of choices on their primary rank order lists, which are considered in rank order when the matching algorithm is processed. Couples match to the most preferred pair of programs where each partner has been offered a position. PGY-1 & PGY-2 Post-graduate year one and post-graduate year two. Program Type The NRMP classifies
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