Robotic Resection of Retroperitoneal Pelvic Tumor

Abstract

<h3>Study Objective</h3> To illustrate a technique of robotic resection of a retroperitoneal pelvic tumor. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> The patient was in the lithotomy position with steep Trendelenburg, intermittent pneumatic compression, and Allen Stirrups. She underwent robotic surgery with side docking. <h3>Patients or Participants</h3> A 48-year-old woman was experiencing pain in her left lower limb for four months. Imaging studies revealed a myomatous uterus and an expansive, complex, heterogeneous formation in the retroperitoneal region of the left pelvic wall, posterior to the iliac vessels and adjacent to the iliac bone, with 8.9cm in the largest diameter and with 140.8mL. The lesion dislocated the left iliac vessels anteriorly, the left psoas muscle laterally, the parametrial structures medially and showed close contact with the anterior part of the left foramina of S1 and S2. The procedure was held at Beneficência Portuguesa Hospital, São Paulo, Brazil. <h3>Interventions</h3> A robotic hysterectomy with bilateral salpingectomy and resection of a retroperitoneal pelvic tumor aided by neuronavigation was performed after simple hysterectomy with vaginal retrieval of the surgical specimen. The tumor, which was bulging the external iliac vessels, was dissected entirely and isolated. The formation was completely resected robotically, with an adequate presentation of the left ureter, left vascular, and nerve structures. <h3>Measurements and Main Results</h3> Surgical intraoperative parameters were measured. The docking time was five minutes, and the robotic surgery took 180 minutes. The estimated blood loss was 200mL. There were no nerve injuries or intraoperative complications, and the patient was discharged 36 hours after surgery. The final pathology report revealed a Myxoid Liposarcoma. <h3>Conclusion</h3> This video demonstrates of a case a robotic resection of a retroperitoneal tumor aided by neuronavigation. This approach was feasible with the benefit of superior imaging affording a three-dimensional vision and stable instruments allowing wrist-like movements.