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Mature teratomas are unique and generally benign neoplasms. They are derived from embryonic tissues and typically located within the gonadal region. Primary retroperitoneal teratomas are uncommon in adults and often challenging to treat, given their location and size. Here, we offer a rare case of a large primary retroperitoneal mature cystic teratoma, detected on abdominal ultrasound during the work-up of abdominal bloating and nausea and treated with robot-assisted laparoscopic excision in a 58-year-old male. In this report, we sought to describe the evaluation, treatment, and follow-up of this condition, as well as review the associated literature.

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The appointments were analyzed the same way to determine success of the interventions.RESULTS: Using the findings from the process maps the team was able to determine wait times and rework as areas for quality improvement. Rework is defined as the technician or provider having to see the patient multiple, separate times during a clinic visit. For example, a patient sees the provider, provider requests post void residual (PVR), patient leaves with technician to get PVR, patient returns to provider. This was considered provider rework. We implemented assigning one technician to one provider, prepping patient charts in advance, and daily huddles. Through these interventions the clinic was able to see significant improvements in all areas of concern. When looking at the provider clinic, the initial wait times dropped by up to 63%. Rework was decreased by 48%. The overall number of technician rework decreased by 17% and overall provider rework decreased by 50%. These decreases saved a median of 6 minutes per visit equaling 98 minutes a day saved. The procedure clinic also saw significant improvements including up to a 43% decrease in the initial wait time, the chance of all rework decreasing by 55%, and the technician rework decreased by 36%. The total length of visit from procedures decreased by 16 minutes or 30%.CONCLUSIONS: Lean methodologies, such as process mapping and PDSA cycles, are an effective way to identify areas for improvement in an outpatient urology clinic. We developed several action items including pairing one technician to one provider, prepping patient charts, and implementing daily huddles. These interventions proved beneficial in reducing waste and operating a more effective and efficient clinic.

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