Iswanto Sucandy, MD, Sharona B Ross, MD, FACS, Thaeri Cortes, BS, Janelle Spence, BS, Alexander S Rosemurgy, MD, FACS. Florida Hospital Tampa
Introduction: Leiomyosarcoma is an uncommon soft tissue malignancy associated with poor prognosis. In the literature, only few cases of localized small leiomyosarcoma have been described. Most abdominal leiomyosarcoma is resected through traditional “open” operation. Robotic technique offers many technical advantages over “open” operation and conventional laparoscopy. We aim to report our approach of minimally invasive robotic resection of leiomyosarcoma.
Methods: A preoperative CT scan showed 5.5 cm PET avid mass in the porta hepatis, portal hypertension, cavernous transformation of portal vein, and 1cm arterially enhancing segment 6 liver mass. The operation was undertaken using a robotic system with 5 port technique. Robotic ultrasound was used to systematically examined the liver. The segment 6 liver mass was ablated using microwave technology.
Results: 66 year old man presented with constant dull epigastric pain and 12 lb weight loss. The background liver is only minimally cirrhotic. Percutaneous needle biopsy showed sarcomatoid/spindle cell carcinoma. The porta hepatis mass was located in the gastrohepatic space, anterior to the caudate lobe and inferior vena cava. Circumferential dissection was carefully undertaken using robotic bipolar forceps and hook cautery while avoiding injury to the common hepatic artery and coronary vein located nearby. Laparoscopic retrieval bag was used to remove the specimen. Operative time was 120 min with 50 cc of estimated blood loss. No intraoperative complications were seen. Patient had an uneventful postoperative recovery with 2 days of hospital stay. Final pathological report showed high-grade leiomyosarcoma (>50 mitosis per 10 high power fields) and the resection margins were negative for malignancy or neoplasia.
Conclusions: Robotic approach for resection of leiomyosarcoma is safe and feasible in select cases, even in the setting of portal hypertension. Reported technology extends the application of minimally invasive technique in complex abdominal operation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95856
Program Number: V175
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop