Safe robotic resection of a rare low-grade pelvic presacral mesenchymal tumor - case report.

Introduction and importance: Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that may reach considerable size in the lesser pelvis before becoming symptomatic. Surgical treatment is challenging because of the deep pelvic location, its proximity to major vessels and autonomic nerves, and frequent tumor hypervascularity. Presentation of case: We report the case of a 32-year-old woman presenting with persistent gluteal pain. Imaging studies revealed a hypervascularized presacral mass measuring 58 × 46 × 78 mm, adherent to the posterior rectal wall without evidence of infiltration. The patient underwent robotic radical resection using the da Vinci Xi system with 50 mL blood loss. Pathological analysis confirmed a low-grade SFT with characteristic immunohistochemical profile (CD34 and STAT6 strongly positive) and negative surgical margins (R0). The postoperative course was uneventful. After 6-month follow-up, no evidence of recurrence was observed. Clinical discussion: In hypervascularized presacral SFT, the aim is to minimize intraoperative bleeding and achieve R0 resection. Robotic surgery allows for precise visualization of the tumor margins and of the vascular and neural structures in the lesser pelvis. In such procedures, the surgical stages must be planned correctly, based on imaging studies and the main sources of vascularization. Conclusion: The robotic abdominal approach may be a safe and effective option for the resection of presacral SFT, offering precise dissection and effective hemostasis. Further studies are required to confirm long-term oncological outcomes in robotic SFT resection.