Totally laparoscopic excision of a retroperitoneal lipoma extending into the inguinal canal: a rare case report with intraoperative video.

Introduction: Retroperitoneal lipoma extending into the inguinal canal is extremely rare. Its distinction from well-differentiated liposarcoma can be challenging. This report describes the first case of a totally laparoscopic intraperitoneal excision and highlights the anatomical considerations necessary for a safe resection. Presentation of case: A 58-year-old woman presented with a long-standing, non-reducible right inguinal bulge. Magnetic resonance imaging and computed tomography revealed a homogeneous lipomatous mass arising at the right pelvic inlet, protruding through the internal inguinal ring, and compressing the bladder and cecum without invasion. Laparoscopic resection was performed under general anesthesia using five ports. The tumor was dissected carefully along the external iliac vessels. The round ligament was divided to mobilize the mass from the inguinal canal. The enlarged internal inguinal ring was closed with continuous barbed suturing. Mesh placement was avoided in consideration of the benign characteristics of the lesion. The specimen measured 13.5 × 11.0 × 3.0 cm. Histopathology confirmed mature adipose tissue negative for MDM2 and CDK4. Recovery was uneventful. The patient was discharged on postoperative day 4. Discussion: A totally laparoscopic intraperitoneal approach provides excellent visualization of pelvic anatomy, thereby facilitating safe dissection and anatomical repair with minimal invasiveness. This technique might be a less invasive alternative to open surgery when malignancy is not suspected. Conclusion: This case suggests a totally laparoscopic approach as a feasible, minimally invasive option for treating a retroperitoneal lipoma with inguinal extension.