Robotic-Assisted Excision of Inferior Vena Cava Leiomyosarcoma

Abstract

Leiomyosarcomas of the retroperitoneum are rare, and robotic management of inferior vena cava (IVC) leiomyosarcomas is unprecedented. We present the first reported case of a robotic-assisted excision of a 7 cm IVC leiomyosarcoma in a 45-year-old female with diabetes. Using the da Vinci Xi system, the surgery involved a 10-minute dock time, 180-minute console time, and 29-minute clamp time, with 800 mL blood loss. The tumor, measuring 8 × 7 × 4 cm, was successfully excised with negative margins. The patient was discharged on postoperative day 1, demonstrating the procedure’s feasibility and safety.

Introduction:

Leiomyosarcomas of the retroperitoneum are relatively rare tumors for urologists and uro-oncologists to manage. There is no reported literature on the robotic management of leiomyosarcoma of the inferior vena cava (IVC). ¹ To date, a video presentation of the excision of leiomyosarcoma from the renal vein using robotic surgery has been reported by Vicente et al. ² A 45-year-old woman patient with diabetes and no other comorbidities was incidentally found to have a 7 cm retroperitoneal mass originating from the IVC during a health checkup, with no evidence of infiltration into surrounding structures or nodal involvement on contrast-enhanced computed tomography. Preoperative creatinine was 0.8 mg/dL. She was managed by a robotic-assisted approach, making this the first reported case of robotic management of an IVC tumor.

Materials and Methods:

The patient underwent robotic-assisted surgery using the da Vinci Xi system. She was positioned in the left lateral position, and standard ports for a robotic right radical or partial nephrectomy were utilized, including four 8 mm ports (three working and one camera) and two assistant ports (one 12 mm and one 5 mm).

Results:

Key operative metrics included a dock time of 10 minutes, a console time of 180 minutes, and a clamp time of 29 minutes. Intraoperative blood loss was 800 mL. The excised tumor measured 8 × 7 × 4 cm and was histologically confirmed as a leiomyosarcoma with all margins negative. The patient was discharged on postoperative day 1. The patient is disease free at 3 months follow-up with preserved serum creatinine same as preoperative level.

Conclusion:

This case demonstrates the feasibility and safety of robotic-assisted surgery for managing leiomyosarcoma of the IVC.

Conflicts of Interest:

No conflicts of interest as signed by all authors. Form enclosed as separate attachment.

Runtime of video: 5 min 25 sec.