1734 Resection of a Retroperitoneal Mature Teratoma Causing Severe Urinary Symptoms

Abstract

Video Objective The objective of this video is to depict a robotic assisted laparoscopic resection of a retroperitoneal mass, showing a unique case where compression on the pelvic splanchnic nerves produced severe urinary symptoms in a patient which resolved immediately after the procedure. It also shows a rare case of extraogonadal retroperitoneal mature teratoma. Setting The patient is a 28 yo G1P1 who presented to care for worsening left lower quadrant pain and pressure, urinary frequency, urgency and hourly nocturia. History is significant for dysmenorrhea, abdominoplasty and acne taking spironolactone. Imaging revealed a mildly complex mass in the cul-de-sac measuring 10.6\u202f×\u202f8.3\u202f×\u202f7.3 cm, without thickening or nodularity, probably cystic and arising from the left ovary. She underwent laparoscopy for planned excision which was aborted as a retroperitoneal mass was identified involving the cul-de-sac and left pelvic sidewall without involvement of the ovaries, fallopian tubes and uterus. She was then referred to Gynecologic Oncology, Neurosurgery and then by Urogynecology. Interventions She underwent a robotic assisted laparoscopic removal of the left retroperitoneal mass with care to avoid use of excessive cautery, excision of endometriosis, left ureterolysis, enterolysis, peritoneal biopsy and cystoscopy with a intraoperative left ureteral stent placed by Urology, removed at the end of the case. After removal of the mass her urinary symptoms and pelvic pain completely resolved. Her postoperative course was uncomplicated. Pathologic findings of the retroperitoneal mass were consistent with a mature teratoma. Conclusion The retroperitoneal teratoma compressed the inferior hypogastric plexus which led to the patient s symptoms. Careful dissection of the pararectal and paravesical space was performed to cause minimal damage to the inferior hypogastric plexus and surrounding nerves with complete resolution of symptoms. Limited use of electrocautery was employed to avoid thermal damage. Extragonadal teratoma is a rare finding.