A 56-year-old woman was initially evaluated for intestinal disorders.
Physical examination and initial laboratory routine were normal.
Abdominal ultrasound showed a solid mass of 12 cm behind the left kidney with abnormal vascularization.
Computed tomography showed a well circumscribed mass behind the left kidney that enhanced after intravenous contrast administration and showed a clear fat plane between the left kidney and the mass.
A needle puncture was performed to obtain histology.
The pathology report of a mesenchymal tumor or a low malignant potential.
Laparoscopic exploration was decided.
1.
Surgical technique: Under general anesthesia, the patient was placed in the right lateral decubitus position after orogastric and bladder catheterization.
A single dose of intravenous cephalothin 2gr is administered.
Pneumoperitoneum was performed with Veress needle at 1 2 mmHg.
Two trocars of 1 2 mm and 5 mm respectively were placed a lead as shown in Figure 3.
The colon and the spleen were widely mobilized towards the midline.
After opening the germinal fascia, the mass was clearly visualized on the external edge of the kidney.
Preservating the tumour boundaries, the same was cleared from contact with the renal capsule.
An area of 2cm firmly adhered to the renal capsule requiring resection of the capsule and subsequent fulguration of the bloody bed with argon laser was observed.
The surgical specimen was extracted in a plastic bag by extending the left flank trocar incision obliquely.
A Blake-type drainage was left through the trocar orifice of 5 mm. Operative time was 135 minutes with estimated bleeding of 200 ml.
The patient was discharged on the third postoperative day.
Final pathological analysis revealed a leiomyosarcoma with a very low malignancy grade.
After a 6-month follow-up, the patient recovered completely without evidence of her underlying disease.
