Laparoscopic Resection of a Retrorectal Presacral Schwannoma of the S2 Nerve Root

Stephanie L Koonce, MD, Mark A Pichelmann, MD, Ron G Landmann, MD. Mayo Clinic Florida

Laparoscopic resection of primary colon and rectal masses is well established. Retrorectal/presacral tumors are rare with schwannomas being the most common presacral neurogenic tumor. Surgical excision of these high tumors is traditionally performed via a midline laparotomy. Few reports of laparoscopic resection of such tumors are found in the literature. This is a video case presentation of a 70-year-old female with a symptomatic left S2 sacral nerve root schwannoma. This video presents a laparoscopic resection of the retrorectal S2 peripheral nerve root schwannoma, describes operative tips to aid in exposure of such tumors including mobilization of the rectum with retraction via an intracorporeal and extracorporeal retraction, and highlights some technical and anatomical challenges presented by this mass. The laparoscopic approach offers improved visualization and exposure of vital structures and minimizes patient morbidity. The patient has had no recurrence at over 6 month follow up.

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