Robotic Management of Pelvic Lipomatosis-Experience with Difficulties Encountered and the Techniques to Successful Outcomes.

ABSTRACT

BACKGROUND: Pelvic lipomatosis (PL) is a rare condition characterized by diffuse pelvic overgrowth of nonmalignant but infiltrative adipose tissue in perivesical and perirectal space. OBJECTIVE: To share our robotic experience and difficulties encountered and suggested techniques to overcome them successfully. It is the first series from India. DESIGN SETTING AND PARTICIPANTS: A prospective observational study was conducted. All consecutive patients diagnosed with PL between 2016 and 2019 underwent robotic-assisted wide bladder fat extirpation and bilateral ureteral reimplantation (extravesical refluxing type) with double J stenting and were evaluated prospectively. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Demographics, serum creatinine level, radiographic features, postoperative complications, and patient-reported outcomes were evaluated. Continuous variables are presented as median and range, as the sample size is very small. RESULTS AND LIMITATIONS: We encountered a total of five patients with PL. The median console time was 126 (range 120-130) min, with a median estimated blood loss of 120 (range 100-150) ml. Postoperative complications were Clavien-Dindo grade I in three cases, and the median hospital stay was 2 d. Distal ureteric margins showed subepithelial edema with submucosal fibrosis, and bladder fat biopsies were reported as adipose tissue with hemorrhage. At initial 3-mo and annual follow-ups, all patients had normal serum creatinine and there was no evidence of disease recurrence. Limitations of our study are the very small sample size (a low incidence of PL) and short follow-up time period (the question of how long the surgical effect will be sustained due to abnormal proliferation of fat cells remains unanswered). CONCLUSIONS: Robotic management of wide bladder fat extirpation and bilateral ureteral reimplantation with double J stenting has a good success rate and good outcome in PL. PATIENT SUMMARY: Pelvic lipomatosis is a very rare condition. Robotic management in treating the condition has good outcome for the patient. Here, we have discussed the difficulties encountered in treating the condition and the techniques used to overcome them.