LAUSR

Aggressive angiomyxoma is a rare mesenchymal tumor, typically arising in the soft tissue of the pelvis and perineum, with local aggressive behavior and frequent local recurrence. Surgical excision is the standard treatment, and it is especially relevant to acquire negative pathologic margins to reduce the local relapse. We report the case of a 47 yearold woman diagnosed with an aggressive angiomyxoma of the pelvis and perineum. A magnetic resonance imaging (MRI) scan revealed a 9 cm infiltrative mass at the level of the lateral wall of the left introitus, extending to the left infravesical space, lateral wall of the vagina and anal sphincter, infiltrating the levator ani muscle and the ischiorectal fossa. A surgical treatment was performed consisting first of a robotic approach with standard fiveport placement configuration. The surgical strategy initially consisted of the development of the lateral avascular spaces of the left pelvis. The first maneuver involved the detachment of the tumor from the obturator fossa and left lateral wall of the bladder by developing also the medial paravesical space. Then, development of the Retzius space up to the bladder neck was achieved to identify the prevesical portion of the tumor. The use of intravenous indocyanine green helped us to identify the anatomical plane for the detachment of the tumor from the bladder. Next, a vaginal approach with a longitudinal incision was performed, enabling us to identify Figure 1 Bladder detachment of the prevesical portion of the aggressive angiomyxoma.