Abstract
Reports in the literature have presented the feasibility of a minimally invasive resection of retroperitoneal or pelvic schwannomas. However, there are only a few reports in the literature about a robot-assisted nerve-sparing approach towards obturator schwannomas.We present a case of a concomitant excision of a symptomatic obturator nerve schwannoma in a patient undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy. The patient complained about an ongoing, low-grade sensory dysfunction in the left proximal thigh area, without loss of muscular function. A preoperative pelvic MRI incidentally showed a thickening of the left obturator nerve of about 1 cm. During pelvic lymphadenectomy, the thickening was identified, an axial incision was made to the nerve sheath, and a small tumor mass (9 mm x 5 mm x 3 mm) was excised, thereby decompressing the nerve fibers and simultaneously preserving the continuity of the obturator nerve. The nerve sheath was closed using a 7-0 monofilament suture. Frozen section biopsy that was undertaken during the surgical procedure excluded the presence of a malignancy.There were no intra- or postoperative complications. Postoperatively, the patient described a temporary sensory dysfunction of the left inner-thigh area, which regressed completely. The histopathological result confirmed a benign schwannoma of the obturator nerve. In experienced hands, the robot-assisted approach appears safe and feasible as a technique to excise a schwannoma of the obturator nerve, without the need to proceed to a full nerve resection.
Highlights
Schwannomas are benign lesions that derive from Schwann cells, which are the cells responsible for the production of the protective myelin sheath that covers peripheral nerves
We present a case of a robot-assisted resection of a symptomatic small mass within the nerve sheath of the left obturator nerve during the lymphadenectomy part of a robot-assisted radical prostatectomy
These benign lesions are mostly diagnosed in the cranial region as acoustic schwannomas/neurinomas and are rarely encountered in the pelvic area
Summary
Schwannomas are benign lesions that derive from Schwann cells, which are the cells responsible for the production of the protective myelin sheath that covers peripheral nerves. A 58-year-old patient with a histologically confirmed intermediate-risk prostate cancer [organ-confined tumor, Gleason score of 7b, bilateral involvement of the gland, prostate-specific antigen (PSA) level: 4.6 ng/ml] presented to the outpatient clinic of our department for a consultation regarding possible treatment options His past medical history revealed two previous surgeries for a lumbar disc herniation, as well as polyarthritic changes to several joints, and a hip joint fracture. The patient received counseling regarding prostate cancer, and he decided to undergo a robot-assisted nerve-sparing radical prostatectomy with simultaneous standard pelvic lymphadenectomy (bilateral external and internal iliac region and obturator fossa).
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