Abstract
An inflammatory myofibroblastic tumor (IMT) can arise anywhere in the body. IMT is a spindle-cell neoplasm not prone to metastasize although it has an important potential of local expansion. We report an IMT in a 55-year-old male who was initially treated with a transurethral resection of the bladder tumor (TURBT) and subsequently underwent a robot-assisted partial cystectomy. Step 1 of the procedure was installation of the patient. Since we performed the procedure with the Da Vinci Xi system®, we were able to install the patient in supine position followed by side docking. Step 2 was marking the tumor in the peritoneum of the bladder dome. During step 3, we developed Retzius' space. Step 4 consisted of using simultaneous cystoscopy, performed by the bedside table assistant, guiding the dissection aiming for complete excision of the tumor with a negative surgical margin of at least 2 cm macroscopically. This was facilitated using the TilePro™ feature that allows simultaneous observation of cystoscopy and laparoscopy image inside the console. Since in this case the tumor originated from the bladder dome, step 5 consisted of excising the urachus en bloc with the tumor. During step 6, we placed the tumor in an Endo Bag. Step 7 consisted of closure of the bladder in two layers using V-lock 3-0. To finish of the procedure, a leakage test was performed, followed by extraction of the tumor in the Endo Bag. No postoperative problems were reported, and the patient was discharged the second day after surgery. Transurethral catheter was removed in the outpatient clinic on day 7, after cystography ensured no leakage was present. Definitive pathologic report confirmed the presence of a spindle-cell proliferation with eosinophilic cytoplasm. A follow-up cystoscopy 5 months after surgery showed no recurrence. Bladder capacity was excellent without any change in micturition pattern. Future follow-up will consist of yearly cystoscopy. When complete resection of IMT with TURBT is not feasible, a robot-assisted partial cystectomy with simultaneous cystoscopy is a minimally invasive option facilitating complete resection with negative surgical margins and maximal preservation of bladder function.
No competing financial interests exist.
Runtime of video: 1 min 58 secs
Get full access to this article
View all access options for this article.