Robotic Resection of a Symptomatic Parasitic Leiomyoma From the Obturator Fossa

To demonstrate a technique for robotically resecting a parasitic leiomyoma from the obturator fossa.

Case report and a step-by-step video demonstration of resection of a symptomatic parasitic leiomyoma (Canadian Task Force classification III).

Tertiary referral center in New Haven, Connecticut.

This 48-year-old Caucasian female had undergone a previous total abdominal hysterectomy for uterine leiomyomas. She presented to her primary care provider with lower back pain radiating to the right groin and with a burning sensation on the medial aspect of the inner thigh. She denied any decrease in leg muscle strength. Pelvic magnetic resonance imaging revealed a 3.3-cm mass in the obturator fossa compressing the obturator nerve. She was subsequently referred to gynecologic oncology for resection of the mass, and was brought to the operating room for robotic resection. Once retroperitoneum on the right pelvic sidewall was explored, ureterolysis was performed. The external iliac artery and vein were then mobilized medially to access the obturator fossa. The mass was visualized at the sidewall. Safe resection of the obturator fossa mass requires identification of the obturator nerve. The specimen was resected off the right pelvic sidewall with traction-countertraction, gentle wiping, and grasping-tenting techniques. It was then placed in a laparoscopic bag and removed from the peritoneal cavity in a contained manner. The procedure was performed without any complications. The patient had an uneventful postoperative course and was discharged to home on postoperative day 0. Pathology revealed a benign leiomyoma. The patient was symptom-free at her 4-week postoperative visit.

Robotic resection of a symptomatic retroperitoneal mass in the obturator fossa was successfully performed, with resulting resolution of obturator neuropathy. Parasitic leiomyomas should be considered in the differential diagnosis for a patient presenting with an intraperitoneal or retroperitoneal mass with a history of previous surgery for leiomyomas.