Abstract:

Objective

To report a case of severe intravenous leiomyomatosis (IVL) managed through robotic surgery and multidisciplinary collaboration.

Methods

In Aug. 2023, a patient with intravenous leiomyomatosis was admitted to the First Medical Center of Chinese PLA General Hospital. The patient presented with multiple uterine leiomyomas and a markedly enlarged uterine corpus. The IVL lesion involved the left parametrium and pelvic floor vasculature, with tumor thrombus extending upward along the left ovarian vein, left renal vein, inferior vena cava, and terminating in the right atrium. A multidisciplinary consultation was convened, involving departments of gynecology, urology, cardiothoracic surgery,ultrasound, radiology, anesthesiology, and other relevant specialties. The lesion was completely resected through robotic surgery and multidisciplinary collaboration. The operative duration was 356 minutes, with an estimated blood loss of 500 ml.

Results

The patient experienced no severe complications during the perioperative period and had an uneventful recovery. She was discharged in improved condition 12 days postoperatively and remained free of recurrence and long-term complications during a 1-year follow-up period.

Conclusion

This case highlights the successful management of IVL through robotic surgery and multidisciplinary collaboration, achieving complete resection of the lesion in a single surgical stage.Minimally invasive surgery, particularly leveraging the advantages of the robotic surgical system and high-level multidisciplinary collaboration, has enabled the effective treatment of such complex and challenging cases.

Key words: Intravenous leiomyomatosis, Robot surgery, Multidisciplinary collaboration, Uterine fibroids, First stage surgery