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An inadvertent rupture of a quiescent urachal remnant may, rarely, occur during a laparoscopic procedure, during port placement. We report a case of a young girl that underwent a robotic-assisted excision of a symptomatic urachal cyst following laparoscopic appendectomy. Case presentation A 15-year-old girl was admitted to our Institution complaining of a supra-pubic abdominal pain. The symptoms lasted for 2 weeks. About 2 months previous, she had undergone a laparoscopic appendectomy for acute appendicitis, and the early postoperative period was uneventful. Moreover, preoperative Pediatric Appendicitis Score (PAS) was 7/10 and abdominal ultrasound had shown an appendix with a 7-mm diameter, with peri-appendiceal fluid. The constant pain she complained of did not radiate and was 5/10 on the pain scale. There were no lower urinary tract symptoms. Urinalysis and blood tests were unremarkable, and C-reactive protein (CRP) was negative. An abdominal ultrasound and a magnetic resonance imaging (MRI) scan did not document any pathological abnormality, rather a supra-vesical cyst consistent with an enlarged urachal cyst (Fig. 1). For this reason, after informed consent was obtained, the patient underwent a robotic-assisted excision of the urachal cyst. Briefly, with © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. * Correspondence: dona.difabrizio@gmail.com 1 Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, Unit of Pediatric Surgery, University of Messina, Messina, Italy Full list of author information is available at the end of the article Annals of Pediatric Surgery Arena et al. Annals of Pediatric Surgery (2021) 17:11 the patients in supine and Trendelenburg position, a 2- cm-long incision was performed above the navel, opening the fascia and accessing the abdominal cavity with trocar placement for optics. After induction of pneumoperitoneum at 12 mmHg, another 8-mm robotic trocar and two assistant ports, one 5 mm and one of 12 mm, were positioned according to the scheme for surgery in the lower pelvis. A lysis of some adhesions between the intestine and the abdominal wall was performed. related to a rhinoplasty, facelift, blepharoplasty, or laser resurfacing. In contrast, there are also very specific physical factors that contribute to the assessment of each individual treatment outcome. For example, nasal airway functioning should be a concern for any rhinoplasty surgeon and clearly affects the quality of life of the rhinoplasty patient. The appearance of being tired is a specific complaint of the preoperative blepharoplasty patient that should be addressed with eyelid surgery. Measuring Effectiveness Outcomes can be defined in many ways, depending upon the interests of the investigating clinician and the patient population being evaluated. Most authors agree that an assessment of patient-related quality of life should inFig. 1. Quality of life instrument. 194 Outcomes in Facial Plastic Surgery clude components of physical, mental, and social functioning and should reflect the satisfaction and opportunity of the individual subject [1,2]. In order to compare patient-related outcomes for different sorts of procedures or among different surgeons, it is important to have a standardized instrument that can be used to measure patient quality of life or satisfaction. Such an instrument should tap each of the different domains of an individual’s quality of life and represent an assessment that captures the overall satisfaction with a given intervention. Four new quality of life instruments have been developed and are presented here for the common procedures of facial plastic surgery: the Rhinoplasty Outcomes Evaluation (ROE), Facelift Outcomes Evaluation (FOE), Blepharoplasty Outcomes Evaluation (BOE), and the Skin Rejuvenation Outcomes Evaluation (SROE) (Figs. 1–4) The goal of these instruments is to provide a starting point for individual facial plastic surgeons to evaluate the outcomes of these common procedures in a quantitative fashion. This will allow further assessment of patient satisfaction as well as provide the means by which new or innovative procedures can be compared with more traditional approaches. Scoring of each of these instruments is straightforward and designed to allow the surgeon to easily compare preand postoperative measurements. Each of the six items is scored on a 0–4 scale, with 0 representing the most negative response and 4 representing the most positive response. Dividing the total score for each instrument by 24 and multiplying by 100 yields the scaled instrument score. This range is 0–100, with 0 representing the least patient satisfaction and 100 representing the most patient satisfaction. These four instruments have not yet been pilot tested Fig. 2. Quality of life instrument. R. Alsarraf 195 to assess their reliability and validity, however, these tests are currently planned. If the reader is interested in participating in these pilot tests, as well as the modification or amending of these questionnaires as this testing proceeds, he or she is encouraged to contact the author to be involved in this process. The ease and simplicity of instrument administration should allow efficient validation of these instruments, and hopefully provide the facial plastic surgeon with a quantitative method of outcome assessment. Conclusions Outcomes research attempts to quantitate patient-related results of treatment that are otherwise subjective and difficult to understand or study in a comprehensive fashion. The use of standardized instruments specific to the treatment or illness in question allows the outcomes researcher the method to measure patient satisfaction, functionality, and quality of life and use these measurements to compare the results for an individual subject, across different surgical approaches, or between different surgeons. The development and testing of such instruments is an important step that establishes the foundation on which further studies may be based. In facial plastic and reconstructive surgery, there are currently no reliable or validated instruments that are widely used for outcomes assessment. The subjective evaluation of patient satisfaction in the basic measure of success of most facial plastic surgery procedures, yet most surgeons have no quantitative means of this assessment. This paper attempts to outline the basic steps in evaluating outcomes in the realm of facial plastic and reconstructive surgery, similar to the outcomes research that is Fig. 3. Quality of life instrument. 196 Outcomes in Facial Plastic Surgery ongoing in other fields of Otolaryngology-Head and Neck Surgery. Four new instruments are presented for the measurement of patient-related outcomes of rhinoplasty, facelift, blepharoplasty, and skin rejuvenation procedures. These instruments provide a simple and expedient assessment of the individual’s quality of life related to the procedure of interest that the surgeon may find useful in the quantitative evaluation of postoperative facial plastic surgery outcomes. References 1. Wilkins EG, Lowery JC, Smith DJ: Outcomes research: A primer for plastic surgeons. Ann Plast Surg 37(1):1, 1996 2. Patrick DL, Erickson P: Health status and health policy: Quality of life in health care evaluation and resource allocation. Oxford Univ Press: NY, 1993 3. Piccirillo JF, Stewart MG, Gliklich RE, Yueh B: Outcomes research primer. Otolaryngol Head Neck Surg 117(4):380, 1997 4. Alsarraf R, Jung CJ, Perkins J, Crowley C, Gates GA: Otitis media health status
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