Robotic approach to the excision of a rare solitary fibrous tumor of the pelvis

A solitary fibrous tumor (SFT) is a rare soft tissue neoplasm that is most commonly seen in the pleura, but in rare cases can also occur within the pelvis[1, 2]. There is limited literature on the robotic approach for management of these tumors, with most reports describing open or traditional laparoscopic approaches[3, 4]. There are no clear evidence-based guidelines for the management of these tumors. This video aims to provide a step-by-step approach for robot-assisted excision of a rare pelvic mass. In this video article (Supporting Information S1: Video), we demonstrate the feasibility and safety of a robotic approach to pelvic mass excision through two cases. Both cases were referred for an incidentally found pelvic mass on computed tomography imaging. Biopsy demonstrated spindle cell neoplasm favoring SFT. Figure 1 is a CT scan from the first patient showing a 4-cm enhancing mass between the bladder and sigmoid colon. Figure 2 is an MRI from the second patient showing a 3-cm mass adjacent to the left seminal vesicle. A standard robotic prostatectomy five-port configuration was used. First, we incised the posterior peritoneum and dissected the overlying fat to clarify surrounding structures. In the first case, the mass was readily identified after incision of the peritoneum. The pelvic mass was circumferentially dissected away from surrounding structures with excellent visualization. In the second case, the seminal vesicles were identified and dissection was carried caudally until the prostate was identified. All cases were completed without the need for open conversion. The estimated blood loss was 20 cc and 30 cc for the first and second case, respectively. Operative time was 80 min for the first case and 140 min for the second case. Patients were discharged on Postoperative Day 1. No complications occurred within 90 days of discharge. Patients obtained surveillance imaging within 6 months of surgery without evidence of recurrence. In conclusion, a robotic approach to the excision of a pelvic SFT is feasible and safe. The robotic approach offers the unique advantage of visibility and access to a relatively smaller pelvic space. Further data is needed to define the patient and oncologic outcomes of robotic surgery for pelvic SFTs. Jonathan Yu contributed to the investigation, data curation, project administration, and original draft preparation. David Wei contributed to conceptualization. Tom Feng took the lead in the conceptualization, review and editing of the manuscript, and supervision throughout the project. The authors declare no conflicts of interest. This case report adheres to the highest standards of ethical conduct in research and publication. Patient information has been appropriately deidentified to protect privacy. This study conforms to the ethical guidelines of the Declaration of Helsinki and relevant institutional standards for the research and publication of anonymized patient data. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.