V09-09: Castleman's Disease: Robotic Excision of a Retroperitoneal Mass
Castleman's Disease is a rare, benign neoplasm of lymphoid tissue, most commonly presenting within the mediastinum. Clinically, it presents as either unicentric or multicentric disease. The hallmark of management of unicentric disease is surgical resection. Management of disease in the retroperitoneum typically involves use of large incisions for maximal exposure, to safely remove the focus of disease. More recently, laparoscopic approaches have been utilized for minimally invasive resection. Robotic assisted techniques add improved visualization, with careful and precise instrumentation in delicate, and difficult to expose, anatomic locations. Within, we present our experience utilizing a robotic approach for the resection of a retroperitoneal mass.
The patient is a forty-six-year-old male, with a history of myotonia and hypertension, who presented to our clinic for excision of a known retroperitoneal mass, due to concern for malignancy. The mass was initially discovered four years prior, when the patient had presented to the Emergency Department with complaints of shortness of breath. He underwent a CT Angiogram of the chest, the lower cuts of which demonstrated a retroperitoneal mass. Subsequent dedicated MRI demonstrated a 3.4 x 2.5 x 3.6 cm left para-aortic lesion, adjacent to the adrenal gland. After workup by Oncology, the patient was recommended for surgical excision and referred to our office for management. The patient subsequently went to the operating room for robotic assisted resection of his retroperitoneal mass.
The patient underwent successful excision of the mass. The adrenal gland overlying the mass was necessarily removed in order to expose and approach the mass safely. The mass was found abutting the aorta, and required careful and delicate dissection in order safely remove. Estimated blood loss was approximately 250 mL and the patient was discharged to home post-operative day two after an uneventful hospital course.
Robotic approaches to the deep retroperitoneal space allow for excellent visualization, coupled with careful and precise dissection, in a difficult to expose location, which is surrounded by major vascular structures. In our case, it facilitated the safe and complete resection of a retroperitoneal mass, the pathology of which demonstrated Castleman's Disease, a rare disorder of angiofollicular lymphoid hyperplasia.