Category: Robotic Surgery: Lower Tract - Benign
Introduction & Objective :
Teratoma is considered as uncommon tumor. It has unique characteristics embryonically as it consists of three germ layers, hence it could virtually harbor any type of tissues. While the majority of teratoma settled in the gonads either in the testes or ovary, an extra-gonadal sites including retroperitonium, sacrococcygeal region and mediastinum have well reported. Owing to the various location of teratoma, a wide range of presentations can be encountered.
Methods : We retrospectively analyzed the data of this 34 year-old male who underwent left orchiectomy due to left testicular seminoma 3 years prior to this presentation, patient with lower abdominal pain, mainly left sided, associated with urgency, frequency and nocturia. There was no history of change bowel habits, weight loss, or anorexia. Physical examination revealed normal vital signs, slight fullness and tenderness in the lower abdomen with normal external genitalia. his laboratories were within normal range including tumor markers (AFP, LDH and HCG).Computed tomography (CT) scan demonstrated a large multilocular cystic lesion that measures 10.3x7.8x8.1 cm soft tissue components. The cyst was abutting left iliac vessels. An ultrasound-guided biopsy was performed which was inconclusive. The patient underwent a robot-assisted resection of the pelvic lesion through a transperitoneal approach. We report this case to enrich the scarce literature and to emphasize the value of robotic technology in treating such rare tumor.
Extra-gondal teratoma, is rare and its pre-operative diagnosis is almost impossible .Although biopsy might be of value, one should not relay on it as its yield can be inconclusive especially in cystic lesion. In this case report we demonstrated that use of surgical robot was critical for the effective removal of this pelvic tumor especially with aid of 4th robotic arm.
Although rare, urologists have to have high index of suspicion for such tumors. In addition, all surgical options, including robotic, have to be considered before embarking into excision.
SECURITY FORCES HOSPITAL
Riyadh, Ar Riyad, Saudi Arabia
Mohammed Almansour, MBBS.
Dr. Mohammed Almansour is a resident in Saudi Training Program of Urology at Security Forces Hospital.