Robotic Resection of a Sciatic Notch Lipoma Using the DaVinci Surgical System: 2-Dimensional Operative Video

Abstract

Sciatic notch lipomas are rare benign fatty tumors that can cause significant morbidity due to compression of the sciatic nerve. Surgical excision is the gold standard treatment, but traditional open techniques are associated with significant risks and prolonged recovery times. Robotic surgery provides opportunity to improve on traditional laparoscopic techniques by allowing better visualization of and access to regions of complex anatomy, including the pelvis. The potential benefits of robotic resection include reduced blood loss, minimized tissue trauma, and shorter hospital stays. Building on robotic techniques previously described by our group, we present a video of a robotic resection of a sciatic notch lipoma using the DaVinci Surgical System. 1,2 The patient consented to the procedure. The procedure begins with the patient in lithotomy position, followed by the establishment of the robotic trocar sites in the peritoneum, including the endoscope, Da Vinci, and assistant ports. The advanced visualization and precise maneuverability allow for careful dissection and identification of vital structures, including the L5 and S1 nerve roots, with minimal tissue manipulation. Subtotal resection of the lipoma was achieved resulting in decompression of the sciatic nerve with preservation of the surrounding structures. This video highlights the technical aspects of the procedure, emphasizing the advantages of robotic assistance, such as enhanced dexterity, precision, and visualization. This new technique offers a promising alternative to open surgery for the management of sciatic notch lipomas, potentially improving patient outcomes and overall surgical experience.