Surgical Characteristics and Technical Challenges
- Transumbilical single-port laparoscopy boasts advantages including cosmetic incision and convenient specimen retrieval; however, it also brings drawbacks such as increased operational difficulty and limited surgical exposure.
- A distinctive technique of this procedure is suspending the peritoneum over the bladder and the ureter to improve surgical visualization.
- The lesion is a cystic-solid mass. Atraumatic graspers were used to hold the tumor, which was completely enucleated via in-situ dissection before being placed in an endobag for extraction, complying with oncologic principles.
Complete ureteral mobilization and partial dissection of the lateral rectal margin are the key technical hurdles for retroperitoneal tumor resection.
Clinical Case History
General Information
Patient aged 72 years old.
Chief Complaint
Pelvic mass detected on physical examination for one week.
Present Illness
The patient was found to have a pelvic mass during a routine physical examination one week prior. She reported occasional dull lower abdominal pain with normal bowel and bladder function, and no other discomforts. Transvaginal ultrasound of uterus and adnexa revealed a mixed echogenic mass in the right adnexal region measuring 42mm×32mm, suggestive of cystadenoma, along with intrauterine effusion sized 16mm×5mm.
Past Medical History
Hypertension, hyperuricemia and hyperlipidemia; no prior surgical history.
Obstetric and Gynecologic History
Gravida 2, Para 1, Abortion 1: one vaginal delivery and one induced abortion.
Family History
No family history of hereditary disorders or malignancies.
Diagnosis
Gynecologic Examination
Atrophic and smooth cervix; small-sized uterus. A mass approximately 4cm×3cm was palpable beside the right uterine corpus, with smooth surface, moderate mobility and no tenderness.
Laboratory Tests
- CA153: 31.4 U/ml (reference range: 0–25 U/ml)
- CA199: 313 U/ml (reference range: 0–27 U/ml)
- HE4: 105 pmol/L (reference range: 0–104 pmol/L)
- CA125: 11.9 U/ml (reference range: 0–35 U/ml)
Pelvic Magnetic Resonance Imaging (MRI)
A cystic-solid mass located posterior to the right uterus with close attachment to the uterus, suspected to originate from the uterus or right adnexa. Differential diagnoses included borderline cystadenoma and degenerated uterine leiomyoma.
Treatment
On March 26, 2026, the patient underwent single-port laparoscopic bilateral adnexectomy + resection of right retroperitoneal pelvic tumor + hysteroscopy + fractional curettage. This surgical video only demonstrates the resection of the right adnexa and retroperitoneal pelvic tumor.
Intraoperative frozen section pathology: Schwannoma.
Final postoperative pathology: Cellular schwannoma with cystic degeneration at the right retroperitoneal pelvic site; no remarkable pathological changes identified in bilateral adnexa; only sparse endometrial stroma without glands detected in endometrial curettage specimens.
Follow-up
Perioperative supportive treatments including prophylactic antibiotics and fluid resuscitation were administered, combined with characteristic Traditional Chinese Medicine therapies. The patient achieved satisfactory recovery.
Two months postoperatively, the patient reported no abdominal pain or other discomforts with well-healed surgical incision.
Surgeon Profile
Li Sijin
MD, Associate Chief PhysicianAttending Physician, Ward 3, Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
Dr. Li completed her Master’s degree in Gynecologic Oncology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, and her Doctoral degree in Integrated Traditional Chinese and Western Gynecology at Guangzhou University of Chinese Medicine. In 2023, she pursued advanced training in standardized diagnosis and treatment of gynecologic malignancies at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences in Beijing.
Her clinical expertise covers minimally invasive individualized surgeries for complex gynecologic malignancies together with integrated Chinese-Western medicine whole-cycle management. She is also proficient in minimally invasive procedures for benign gynecologic disorders such as deep endometriosis and uterine leiomyoma.
She has presided over 3 provincial and ministerial research projects, published 6 SCI and Chinese core journal papers in the past five years, and served as a volume editor for one monograph.
Awards & Honors
- 2023: First Prize, Teaching Competition of Guangzhou University of Chinese Medicine; "Young Model Staff", The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- 2024: Top 10 "Excellent Young Doctors of Yangcheng"; First Prize, 1st Young Physician Case Presentation Competition, Gynecologic Oncology Committee, Guangdong Association of Integrative Medicine
- 2025: Second Prize, National Finals, Young Clinician Clinical Thinking Competition, Cervical Cancer Committee, Chinese Anti-Cancer Association
Academic Society Appointments
- Standing Committee Member, Gynecologic Endoscopy Branch, Guangdong Medical Association
- Youth Committee Member, Gynecologic Oncology Branch, Guangdong Medical Association
- Standing Committee Member, Gynecologic Oncology Branch, Guangdong Society of Medical Education
- Committee Member & Secretary of Pelvic Exenteration Group, Gynecologic Oncology Committee, Guangdong Association of Integrative Medicine
- Committee Member, Ovarian Cancer Committee, Guangdong Anti-Cancer Association
- Committee Member, Young Obstetrics and Gynecology Special Committee, Guangdong Clinical Medicine Society
- Youth Committee Member, Obstetrics and Gynecology Branch, Guangdong Medical Doctor Association
- Committee Member, Gynecologic Oncology Branch, Guangdong Society of Traditional Chinese Medicine
- Standing Committee Member, Fertility and Obstetric-Gynecologic Rehabilitation Management Committee, National Industry Enterprise Management Association of Health Services
- Committee Member, Integrated Chinese-Western Medicine Expert Volunteer Committee
Young Editorial Board Member, Journal of Gynecology and Obstetrics for Chinese Medicine (GOCM)
Editor-in-Charge: QinghuanReviewer: Ma Ye
