Background

Periprostatic masses are rare and of uncertain behavior. They arise from different periprostatic structures such as nerves, vessels, muscle, adipose tissue, among others. They may or may not be associated with LUTS. A histological evaluation is usually indicated as there is risk of malignancy and surgical excision is usually considered. We present a case of a robotic-assisted laparoscopic periprostatic lesion excision.

Case Presentation

Male patient, 51 years old, former smoker, with a past medical history of pulmonary sarcoidosis, hypertension, diabetes and dyslipidemia. Medicated with metformin 1000mg, esomeprazole 40 mg, Valsartan+Hydrochlorothiazide 80+12.5mg and fenofibrate 145 mg. History of exploratory laparotomy in 2006 (diverticulitis). The patient was referred to our clinic after an incidental finding of a periprostatic mass in an abdominal ultrasound. The patient had mild LUTS (IPSS 4), mostly storage symptoms. The MRI showed a “…oval lesion with 28x20x17 mm, in the right lateral aspect of the prostate…without communication with either the prostate or the bladder…”. A biopsy was undertaken and the histology revealed “unspecified fusocelular mesenchymal lesion”.

The patient was proposed for a transperitoneal robotic-assisted laparoscopic excision of the mass. Trocar placement was carried similar to our approach for radical prostatectomies. We have placed a 12 mm port above the umbilicus and 2 ports bilateral in the direction of the iliac crests. We began by accessing the retzius space and identifying the prostate and bladder. We proceeded with dissection in the right lateral aspect of the prostate and we were able to clearly identify the mass. Dissection was carried and the mass was completely removed. Total procedure time was 53 min. Estimated blood loss was 50 mL. Patient was discharged in the next day.

Conclusion

Complete resection of periprostatic lesions is important for appropriate diagnosis and treatment. These lesions are highly variable in their location and may alter the usual anatomy. Robotic surgery allows careful dissection in order to safely remove these lesions.