Laparoscopic Cytoreduction for Benign Multicystic Mesothelioma: A Comprehensive Description of a Pelvic Space-Oriented Peritonectomy.

Abstract

Abdominal multicystic peritoneal mesothelioma (MCPM) is a rare condition characterized by multiple serous cysts, predominantly affecting the pelvic peritoneum.¹ There is no consensus on the clinical management of MCPM, although surgical resection remains the first-line treatment. Given its low malignant potential, the goal is complete cyst removal to alleviate symptoms and improve quality of life.^2,3 In selected cases, laparoscopic surgery offers a less invasive alternative to open surgery, with several advantages, including reduced postoperative morbidity and faster recovery.^4-6 However, owing to the anatomical complexity, the procedure should be performed at specialized centers to ensure optimal outcomes.⁷^,⁸ PATIENTS AND METHODS: This report presents two cases of MCPM in female patients who underwent laparoscopic cytoreductive surgery (CRS). Considering the technical challenges of laparoscopic dissection in the pelvis, this series focuses on a laparoscopic peritonectomy technique guided by the dissection of the pelvic spaces. A video provides the detailed, step-by-step surgical techniques and postoperative course. The two cases illustrate tailored surgical strategies. In the first case, a uterus-sparing approach was employed to preserve the possibility of future heterologous fertility. In the second, a hysterectomy was performed owing to uterine infiltration by cystic disease, with specimen extraction via the transvaginal route, enabling scarless cytoreduction. Despite longer operative times, laparoscopy facilitated faster recovery and shorter hospital stays. Laparoscopic cytoreduction is feasible in selected patients with minimal disease burden. Owing to the surgical complexity, minimally invasive cytoreduction should only be performed after achieving technical proficiency in open cytoreductive surgery. Furthermore, a structured mentoring program and multidisciplinary support are essential for its safe implementation.