Bradaschia Leonardo, Lavagno Federico, Gontero Paolo, Garbossa Diego, Vincitorio Francesca
Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", A.O.U. Città della Salute e della Scienza, University of Turin, 10127 Turin, Italy.
Urology Unit, Department of General & Specialized Surgery, A.O.U. Città della Salute e della Scienza, University of Turin, 10127 Turin, Italy.
Reports (MDPI). 2025 Jun 20;8(3):99. doi: 10.3390/reports8030099.
Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm × 9 cm × 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury.
机器人手术减少了广泛手术入路的需求，并降低了围手术期并发症。特别是，它在狭窄的解剖空间中提供了更高的灵活性、三维可视化和更高的精度。盆腔肿块因其与关键神经血管结构的密切关系而带来重大挑战，使得传统的开放或腹腔镜手术入路更具侵入性且潜在风险更高。因此，机器人辅助切除结合术中神经生理监测，可能为复杂盆腔病变的管理提供一种安全有效的解决方案。一名18岁女性偶然被诊断出骶骨前方有一个11厘米无症状盆腔肿块。最初的鉴别诊断包括神经纤维瘤、畸胎瘤和髓脂肪瘤。组织病理学检查证实为神经节神经瘤。经过多学科讨论，患者使用达芬奇Xi多端口系统接受了机器人辅助整块切除。术前规划借助三维建模和术中导航。手术持续了322分钟。术前和术后的估算肾小球滤过率（eGFR）值分别为145.2毫升/分钟和144.0毫升/分钟。病变大小为11厘米×9厘米×8厘米。主要术中并发症是由于髂静脉紧密附着于肿块而导致的可控性破裂。术后未发生重大并发症（Clavien-Dindo I级）。术后第3天拔除引流管，第2天拔除膀胱导管。患者术后第5天出院，无进一步并发症。骶前神经节神经瘤是手术复杂区域的罕见肿瘤。采用机器人辅助腹腔镜检查并进行神经监测的多学科方法能够实现安全、微创的切除。这种策略可能有助于避免开放手术并降低神经和血管损伤的风险。
