Abstract
Background
Leiomyosarcomas present high postoperative morbidity and poor prognosis [1]. In the literature, only few cases of localized small leiomyosarcoma have been described [2, 3]. These cases might benefit from a minimally invasive approach. Robotic surgery has been claimed to have several advantages over laparoscopy such as enhanced vision and instruments movements which might make more feasible the execution of this type of surgery where partial renal resection is required.
Methods
A 53-year-old female with a medical history of myeloid leukemia and with chronic renal failure (creatinine: 2.6) was referred to our hospital for an incidental finding of right perirenal tumor of almost 3 cm compatible with leiomyosarcoma arising from the right renal vein.
Results
The operation was performed using a Da Vinci Robotic Surgical System model Si (Intuitive Surgical, Sunnyvale, CA, USA).Robotic ports were placed in a standard configuration for minimally invasive right nephrectomy. The dissection started with the partial mobilization of the right liver and Kocher maneuver. After the identification of the inferior vena cava the tumor was finally localized and dissected. Resection ended with a partial right vein resection and suture. Pathological final exam confirmed the diagnosis with margins free from tumor.
Conclusions
In selected cases, robotic resection of leiomyosarcoma might be a safe and feasible procedure in experienced hands.
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References
Eder F, Halloul Z, Meyer F et al (2008) Surgery of inferior vena cava associated malignant tumor lesions. Vasa 37(1):68–80
Alexander A, Rehders A, Raffel A et al (2009) Leiomyosarcoma of the inferior vena cava: radical surgery and vascular reconstruction. World J Surg Oncol 26(7):56
Wachtel H, Jackson BM, Bartlett EK et al (2015) Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: a case series and review of the literature. J Surg Oncol 111(3):328–333
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E. Vicente, Y. Quijano, H. Duran, E. Diaz, I. Fabra, L. Malavé, V. Ferri, S. Lazzaro, D. Kalivaci, and R. Caruso, and Benedetto Ielpo have no conflicts of interest or financial ties to disclose.
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Vicente, E., Quijano, Y., Duran, H. et al. First case of complete full robotic surgical resection of leiomyosarcoma of the right renal vein. Surg Endosc 32, 1072 (2018). https://doi.org/10.1007/s00464-017-5738-z
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DOI: https://doi.org/10.1007/s00464-017-5738-z