V59 - Robotic Assisted Resection Of Pelvic Nerve Sheath Tumor

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Bouran Alkilany, MD

General Surgery Resident-PGY2
Montefiore Medical Center
Montefiore Medical Center
Elmsford, NY, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

HK

Hansea Kim, MD

Resident
Montefiore Medical Center
New York, New York, United States

Disclosure information not submitted.
Ajita Naik, MBBS (she/her/hers)

Resident
Montefiore Medical Center
Montefiore Medical Center
Bronx, NY, United States

Disclosure information not submitted.

Senior Author(s)

JT

James P. Taylor, MBBChir MPH

Assistant Professor of Surgery
Montefiore Medical Center
New York, New York, United States

Disclosure information not submitted.

Author(s)

OW

Othon Wiltz, MD

Assstant Professor of Surgery
Montefiore Einstein
Scarsdale, New York, United States

Disclosure information not submitted.

CME Eligible

Purpose/Background: We present a case of robotic-assisted resection of a pelvic nerve sheath tumor in a 35-year-old man with neurofibromatosis type 1 (NF1), intellectual delay, and prior malignant peripheral nerve sheath tumor (MPNST) of the right thigh and knee. After chemoradiation per ARST0332 and resection of the primary tumor, surveillance imaging revealed a perirectal mass. FNA confirmed atypical spindle cells with extensive necrosis. Colonoscopy excluded rectal invasion. Pelvic MRI showed an 8.8 cm mass adjacent to, but not invading, the hypogastric vasculature. Multidisciplinary planning included preoperative cystoscopy with bilateral ICG injection and right ureteral stent placement.

Methods/Interventions: A robotic approach was utilized with five-port transabdominal access and Pfannenstiel extraction. Dissection began at the mesorectal-retroperitoneal junction, preserving the right ureter, rectum, and seminal vesicle. Complete 360° mobilization of the mass was achieved. Vascular supply from a branch of the internal iliac artery was controlled with a vessel sealer. The tumor was removed intact in an endo-catch bag. Intraoperative ICG angiography confirmed rectal perfusion, and hemostasis was reinforced with hemostatic agents.

Results/Outcomes: This case highlights the utility of robotic surgery in the safe and precise resection of deep pelvic tumors with complex anatomy, particularly in patients with NF1 and metastatic neurogenic tumors. It demonstrates the value of multidisciplinary preoperative planning and advanced imaging in optimizing surgical outcomes.

Conclusion/Discussion: Robotic resection provides a safe and precise resection for deep pelvic mass that might be challenging in other modalities, especially in patients who underwent radiation.