Laparoscopic Resection of a Presacral Schwannoma.

Benign shwannomas are tumors arising from the neural sheath of peripheral nerves (schwannoma cells).The Schwannoma is the most common benign retroperitoneal tumor in adults. Few cases have been reported in the presacral space. Complete resection is treatment of choice for these tumors. To our knowledge not many reports describe the laparoscopic approach for resection of this unusual neoplasm.

Case report:
This is a 27 year-old female that was presented in consultation after she had been diagnosed 2 years ago with a right adnexal paramedian mass. An MRI showed a mass in the presacral space measuring 4.3 x 4.4 x 4.4 cm with demonstrated low signal intensity and did blush with dye. After obtaining informed consent, the patient underwent a diagnostic laparoscopy and biopsy by a gynecologist. Pathology report showed spindle cell neoplasm, possibly a benign nerve sheath tumor. The patient underwent a re-laparoscopy. The pelvic and presacral space was opened by means of blunt and sharp dissection. The mass was dissected from attachments to the retroperitoneal area, placed in an Endobag™ and extracted through the enlarged infraumbilical trocar site. The peritoneal floor was suture closed with a running 2-0 Vycril suture.

Results: No perioperative complication, the patient was discharged home on postoperative day three with an intact neurological exam.

The laparoscopic approach appears to be a safe, feasible option to treat presacral schwannomas. The benefit of this approach was evident by achieving a complete resection of the tumor, short hospital stay, no complications and high patient satisfaction.

Session: Podium Video Presentation

Program Number: V023

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