機械手臂輔助腹腔鏡切除巨大的後腹腔成熟囊狀畸胎瘤-罕見病例報告

徐明蔚、黃志平

中國醫藥大學附設醫院 泌尿部

Robot-assisted laparoscopic excision of a huge retroperitoneal mature cystic teratoma in an adult : a rare case report

Ming-Wei Hsu, Chi-Ping Huang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Abstract

Mature cystic teratomas are usually benign in nature and originate from embryonic tissues, typically found in the gonadal area. Less than 10% to 20% of retroperitoneal teratomas develop in individuals aged over 30. Primary retroperitoneal teratomas in adults are uncommon and often pose treatment challenges due to their location and size.  Surgical resection is essential for both diagnosing and treating these tumors. Robot-assisted laparoscopic removal of primary retroperitoneal tumors has limited documentation, with fewer than 50 cases reported in medical literature. Of them, tumors exceeding 10 centimeters in size are exceedingly rare. We will now share a case with a huge retroperitoneal teratoma who was successfully treated with robotic surgery.

This 57-year-old male with medical history of hyperlipidemia presented to our institution due to an incidental finding of a huge abdominal tumor during abdominal ultrasound.  Abdomen computed tomography revealed One 145x86 mm well-defined mass lesion with prominent fatty density and focal calcification in left suprarenal area, in favor of teratoma(Fig 1). Serum tests including catecholamine metabolites level, cortisol level, renin level and urine VMA were within normal limits. She then underwent robot-assisted laparoscopic left retroperitoneal excision successfully(Fig 2). Docking time was 24 minutes and console time was 116 minutes. Total blood loss was 20 milliliters. Later pathology revealed mature cystic teratoma which contains some hairs, greasy materials, fat and bone(Fig 3).  Postoperative course was smooth without complication and she was discharged on postoperative day 4.

Conclusion

Primary retroperitoneal teratomas are extremely rare, especially in adults. Robot-assisted laparoscopic excision is a safe and effective method of surgical management for large primary retroperitoneal mature cystic teratomas.