Asynchronous abdomino-parasacral resection of a giant pelvic lipoma protruding to the left buttock

Abstract

INTRODUCTIONFew reports detail adequate surgical management of giant pelvic tumors that traverse the sciatic foramen.PRESENTATION OF CASEWe present a case of a giant retroperitoneal pelvic lipoma that presented with a dumbbell shape on imaging, occupying the entire lesser pelvis and protruding to the gluteus through the sciatic foramen. Surgery was performed for en bloc resection of the tumor.DISCUSSIONA parasacral approach with the patient in the prone position was necessary to dissect the tumor in the buttock, manipulate around the sciatic foramen and preserve collateral blood flow for the gluteal muscle. An abdominal approach was also essential to ligate the internal iliac vessels involved in the tumor. Accordingly changings the position of the patient during the operation were required. Division of the sacrotuberous and sacrospinous ligaments and packing of the soft tumor into a plastic bag were useful to pass the buttock portion through the foramen without the tumor breaking off.CONCLUSIONThe asynchronous abdomino-parasacral approach with several turnings of the patient's body and plastic bag packing of the tumor were advantageous to manage en bloc resection of the giant pelvic lipoma presented in this case study.

Combined anterior‐posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell‐shaped tumors

“…This technique was useful for a soft benign tumor, but for other tumors, especially those that are malignant, this method was not good. In 2015, Sato used an asynchronous abdomino‐parasacral approach to resect a large pelvic lipoma. Intraoperative plastic bags were used to wrap the tumor to provide a strong cystic capsule and reduce the risk of tumor rupture.…”

“…Considering the complex anatomical situations in the retroperitoneal space, this type of tumor is very difficult to resect, often thought to be unresectable by many surgeons. Although there have been several reports in recent years on this type of tumor, most are case reports . A standard surgical procedure has not been created.…”

“…Pelvic retroperitoneal dumbbell-shaped soft tissue tumor has a very rare incidence and is hard to treat. [1][2][3][4][5][6][7][8][9] Because of the large potential retroperitoneal space, the tumor often grows without any initial symptoms. When a magnetic resonance imaging (MRI) examination reveals the tumor only after the patient feels discomfort, the tumor has generally already become very large, sometimes large enough to penetrate the greater sciatic foramen, thus a dumbbell-shaped tumor is formed.…”

“…Although there have been several reports in recent years on this type of tumor, most are case reports. [6][7][8][9] A standard surgical procedure has not been created.…”

Laparoscopically Assisted Transperineal Approach in the Management of a Giant Pelvic Lipoma

“…While large retroperitoneal lipomas are rare by themselves, and only few reports are present in the literature, even fewer cases of both intra and extra-pelvic lipomas have been described. 1 , 3 – 5 …”