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Laparoscopic removal of retroperitoneal tumor with hanging inferior vena cava

Ho-Seong Han, Sungho Kim, Yoo-Seok Yoon, Jai Young Cho, YoungRok Choi, Seong Uk Kwon. Seoul National University Bounding Hospital

Background: Laparoscopic resection of retroperitoneal mass is challenging because of its location behind a big vessel and a limited range of laparoscopic instruments. We report a case of a hugh retroperitoneal paraganglioma that was successfully excised laparoscopically using the hanging maneuver.

Method: A 67-year-old female had abdominal mass detected during routine check-up. She denied symptoms associated mass. Hematologic and biochemical investigations reveal normal results and hormone tests reveal no abnormal results. Preoperative CT shows retroperitoneal tumor, measuring 6.1cm in diameter, closely adhere to right adrenal gland and possibility of origin from adrenal gland. Briefly, three 12mm trocars and two 5mm trocars were used.

In peritoneal cavity, we can see severe adhesion because of previous subtotal gastrectomy history due to gastric polyp about 30 years ago. After adhesiolysis, the mass was found underlaid inferior vena cava. The mass was carefully dissected and separated from duodenum and inferior vena cava as well as right adrenal gland. Inferior vena cava was hanged up by using vascular tape. The mass was covered by several fibrotic tissue, dissected with ligasure. The feeding vessels to mass were identified and clipped, then subsequently sealed and divided. After removal of excised mass in plastic retrieval bag, Jackson Pratt drain was placed around inferior vena cava.

Result: Laparoscopic retroperitoneal excision for paraganglioma was performed successfully without intraoperative complication and transfusion. The operation time was 190 minutes, and estimated blood loss was 100 ml. The patient was discharged on postoperative day 5 without complications. Final pathologic result was paraganglioma of 7.5 cm sized with PASS score 4.

Conclusion: Laparoscopic surgery with the hanging maneuver for a hugh retroperitoneal paraganglioma beneath inferior vena cava was successfully performed.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80597

Program Number: V154

Presentation Session: Solid Organ Video Session

Presentation Type: Video

36

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