Robotic Excision of Disseminated Peritoneal Leiomyomas

Abstract

Study Objective

To demonstrate a minimally invasive surgical approach to disseminated peritoneal leiomyomatosis.

Design

Case report.

Setting

Tertiary medical center.

Patients or Participants

36-year-old G0 with prior myomectomy with use of power morcellator and now disseminated peritoneal leiomyomatosis undergoing fertility sparing management.

Interventions

The patient underwent a successful robot-assisted laparoscopic myomectomy, abdominal wall mass excision, and excision of abdominal and pelvic masses. Key surgical steps illustrated include:

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  Image guided mapping of lesions
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  Port placement for multi-quadrant visualization
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  30° camera supraumbilical
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  Port hopping feature
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  Use of vessel sealer
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  Identification of vital structures
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  Resection of myomas
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  Traction-Countertraction
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  Blunt and sharp dissection
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  External downward pressure for identification of intramuscular masses
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  Repair of fascial defect
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  Abdominal survey - “run the bowel.”
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  Specimen bagging and cold knife morcellation

Measurements and Main Results

Patient was discharged home on the day of surgery with an uncomplicated post-operative course.

Conclusion

Utilization of Da Vinci Xi Robotic Surgical System features and multidisciplinary planning allow strategic surgical approach and adequate visualization of the abdomen and pelvis to resect leiomyomas in unusual locations.