Aurelio Francisco Aranzana Gomez, Jara Hernandez Gutierrez, Beatriz Muñoz Jimenez, Juan S Malo Corral. CH Toledo
Introduction: Retroperitoneal primary tumors comprise a great variety of neoplasm with different histological typologies, with insidious clinical symptoms and little specificity in most cases. Its diagnosis is established through imaging tests and anatomopathological study is needed so complete surgical resection is the treatment of choice.
The aim of the video is to demonstrate the safety and efficacy of the minimally invasive approach in patients with retroperitoneal lesions. A clinical case of RETROPERITONEAL TUMOR OF UNCERTAIN ORIGIN is presented.
Methods and Procedures: Clinical case: A 66-year-old female patient who, in the course of an abdominal pain at the right iliac fossa suspected of possible acute appendicitis, is diagnosed with a right retroperitoneal tumor of approximately 3 cm, compatible with PRIMARY TUMOR NEUROGENIC ORIGIN on a CT that was performed. Radiographic imaging is a key component of the evaluation of a patient with a retroperitoneal mass, a CT scan is necessary to evaluate the primary site as well as to rule out metastatic disease. After complete biochemical study, non-functioning tumor is determined. The study is completed with MRI where the lesion is located below the right kidney, in front of the right psoas muscle and lateral to the inferior vena cava, and without contact with these structures. The tumor shows a homogeneous signal, being hypointense in T1 and slightly hyperintense in T2. ??It is in intimate contact with the ovarian vein. The complementary tests and iconography of interest of the case are exposed. Surgical intervention is proposed with a laparoscopic approach to remove the tumor.
Results: Full minimally invasive approach in left lateral decubitus position: 4 trocars – lateral laparoscopic transabdominal approach. Laparoscopic liberation of the right colon, Kocher maneuver until the inferior vena cava is visualized, identification of a tumor of approximately 5 cm in the right infrarenal region, lateral to the right ureter, which includes the gonadal vessels. Resection of the tumor in block with margins previous dissection and clipping of the proximal and distal gonadal vessels with Ligasure®. Appendectomy with endoGIA. The patient presented a successful postoperative recovery, being discharged 24 hours after the intervention. Definitive result of the specimen: Leiomyosarcoma, grade 2 of the FNCLCC with negative margin.
Conclusion(s): The laparoscopic approach is a safe and effective technique in the approximation of retroperitoneal tumors, a radical oncological criterion is always needed with correct margins of resection especially in those of uncertain etiology.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94358
Program Number: V225
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop