Laparoscopic treatment of a retrorectal solitary fibrous tumor

Historically, solitary fibrous tumors were thought to arise from the pleura, but solitary fibrous tumors arising from extrathoracic sites have been reported in increasing frequency. This is the case of a 32-year-old woman presenting with unspecific discomfort. An 8cm-diameter round tumor situated just posterior to the middle third of the rectal ampulla is diagnosed. The laparoscopic approach is demonstrated.

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Laparoscopic treatment of a retrorectal solitary fibrous tumor

Authors

EM Targarona, F Marinello, Luis Pallarés, M Trías

Abstract

Historically, solitary fibrous tumors were thought to arise from the pleura, but solitary fibrous tumors arising from extrathoracic sites have been reported in increasing frequency. This is the case of a 32-year-old woman presenting with unspecific discomfort. An 8cm-diameter round tumor situated just posterior to the middle third of the rectal ampulla is diagnosed. The laparoscopic approach is demonstrated.

Catégorie

contribution

Mots-clés

Laparoscopic treatment, retrorectal solitary fibrous tumor

Type de vidéo

Vidéo chirurgicale

Durée

06'04''

Publication

2010-11

Popularité

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E-publication

WeBSurg.com, Nov 2010;10(11).
URL: http://www.websurg.com/doi-vd01en3114.htm

Laparoscopic treatment of a retrorectal solitary fibrous tumor

1. Clinical case presentation 00'19''

This is the case of a 32-year-old woman presenting with unspecific discomfort. An 8cm-diameter round tumor situated just posterior to the middle third of the rectal ampulla is diagnosed.

2. Identification of tumoral lesion 00'38''

Access is gained to the abdominal cavity. Trocars are placed in the conventional position for true pelvis surgery. An approximately 8cm-diameter tumoral lesion is observed. It seems located behind the rectal ampulla inside the mesorectum.

3. Presacral space access 01'05''

The anatomical relationships of this tumor are explored. To do so, the left pararectal peritoneum is divided, and access is gained to the presacral space using a 10mm trocar through which the scope is introduced, a 5mm trocar for the ultrasonic scalpel, and a 3mm trocar for manipulation and dissection. The right pararectal parietal peritoneum is then divided. The prerectal space is entered. The structures of the presacral space are divided, preserving the inferior hypogastric nerve rami. After mobilization, dissection of the presacral space is continued until almost reaching the pelvic floor.

4. Tumor dissection 02'17''

A well-delimited tumor is found. It is seemingly placed inside the mesorectum. Blunt and sharp dissection are simultaneously used for enucleation of the tumor. A cleavage plane is found. It separates the tumor from the posterior aspect of the rectum and of the rectosigmoid junction.

5. Vascular division 02'50''

The tumor is cautiously dissected. Several vascular pedicles originating from the superior hemorrhoidal artery are divided. Dissection is carried on. It is not easy, as the tumor is quite large. It can be observed that the tumor does not involve the posterior aspect of the rectal ampulla and that it can be entirely removed laparoscopically.

6. Completion of dissection 04'16''

The blunt dissection allows to realize that the inferior pole of the tumor reaches the coccyx area and the lower third of the rectum. The entire tumor can be eventually enucleated, preserving the integrity of the capsule and avoiding any potential conflict with the posterior wall of the rectum.

7. Specimen extraction 05'13''

The hemostasis of the presacral space is controlled. The surgical procedure is completed by making a small suprapubic incision in order to introduce a large extraction bag allowing for the removal of the whole specimen. A presacral drainage is placed. It will be exteriorized through the orifice of the right iliac fossa. The conclusive pathological diagnosis was the following: solitary fibrous tumor located in an uncommon position —the presacral space— and belonging to the retrorectal tumor diagnosis group.