Background Abdominal multicystic peritoneal mesothelioma (MCPM) is a rare condition characterized by multiple serous cysts, predominantly affecting the pelvic peritoneum.<CitationRef CitationID="CR1">1</CitationRef> 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.<CitationRef CitationID="CR2">2</CitationRef>,<CitationRef CitationID="CR3">3</CitationRef> In selected cases, laparoscopic surgery offers a less invasive alternative to open surgery, with several advantages, including reduced postoperative morbidity and faster recovery.<CitationRef AdditionalCitationIDS="CR5" CitationID="CR4">4</CitationRef>–<CitationRef CitationID="CR6">6</CitationRef> However, owing to the anatomical complexity, the procedure should be performed at specialized centers to ensure optimal outcomes.<CitationRef CitationID="CR7">7</CitationRef>,<CitationRef CitationID="CR8">8</CitationRef> 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. Results 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. Conclusions 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.

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

期刊论文
发表日期：

2025年7月16日

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Matteo Aulicino,
Carlo Abatini,
Federica Ferracci,
Giorgio D’Annibale,
Claudio Lodoli,
Andrea Di Giorgio,
Miriam Attalla El Halabieh,
Luca Palmieri,
Riccardo Oliva,
Valerio Gallotta,
Fabio Pacelli,
Francesco Santullo

摘要

Background

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.

Results

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.

Conclusions

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.