Surgical Endoscopy

, Volume 30, Issue 10, pp 4640–4645 | Cite as

Laparoscopic resection of paraaortic/paracaval neurogenic tumors: surgical outcomes and technical tips

  • Takashige AbeEmail author
  • Ataru Sazawa
  • Toru Harabayashi
  • Yuichiro Oishi
  • Naoto Miyajima
  • Kunihiko Tsuchiya
  • Satoru Maruyama
  • Hiromi Okada
  • Nobuo Shinohara
Dynamic Manuscript



Due to variations in location and size, laparoscopic surgery for paraaortic or paracaval neurogenic tumors is challenging. We evaluated the surgical outcomes, as well as surgical tips and tricks.


Between 2000 and 2015, 25 procedures were performed in 24 patients. One patient underwent second surgery due to the recurrence of paraganglioma. Data were collected on the tumor diameter, tumor location, perioperative outcomes, pathology, and last-known disease status. Regarding the operative procedures, we reviewed the operative charts or videos to identify surgical tips and tricks.


The median tumor diameter was 5.0 cm (range 1.5–10). The tumor location was suprahilar in 10, hilar in 6, and infrahilar in 9 cases. Regarding the approach, a transperitoneal approach was selected in 24 cases and retroperitoneal approach in 1. The median operative time and blood loss were 208 min (range 73–513) and 10 mL (range 0–1020), respectively. No patient required blood transfusion or conversion to open surgery. Pathological examination revealed paraganglioma in 12, ganglioneuroma in 7, and schwannoma in 6 cases. At the last follow-up, 23 patients were free of disease, while one patient developed metastatic multiple recurrence of paraganglioma 54 months after the second laparoscopic surgery. A review of the surgical records revealed several tips and tricks, including taping the vena cava/renal vein (n = 2) being helpful for detaching a retrocaval tumor from these great vessels, or rotating the kidney to provide a favorable operative view of tumors behind the renal hilum (n = 2). In recent cases, 3D-CT was helpful for preoperative planning.


Laparoscopic resection of paraaortic or paracaval neurogenic tumors is feasible in experienced hands. Surgeons should be familiar with detaching maneuvers around great vessels and the mobilization of adjacent organs. Careful preoperative planning is mandatory.


Neurogenic tumor Paraganglioma Laparoscopic surgery 


Compliance with ethical standards


Takashige Abe, Ataru Sazawa, Toru Harabayashi, Yuichiro Oishi, Naoto Miyajima, Kunihiko Tsuchiya, Satoru Maruyama, Hiromi Okada, and Nobuo Shinohara have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MOV 127007 kb)

Supplementary material 2 (M4 V 17834 kb)

Supplementary material 3 (M4 V 20594 kb)

Supplementary material 4 (M4 V 13534 kb)


  1. 1.
    Chung L, O’Dwyer PJ (2013) Laparoscopic resection of paraaortic or paracaval lesions: feasibility and outcome. Surg Endosc 27:4153–4156CrossRefPubMedGoogle Scholar
  2. 2.
    Goers TA, Abdo M, Moley JF, Matthews BD, Quasebarth M, Brunt LM (2013) Outcomes of resection of extra-adrenal pheochromocytomas/paragangliomas in the laparoscopic era: a comparison with adrenal pheochromocytoma. Surg Endosc 27:428–433CrossRefPubMedGoogle Scholar
  3. 3.
    Misra MC, Bhattacharjee HK, Hemal AK, Bansal VK (2010) Laparoscopic management of rare retroperitoneal tumors. Surg Laparosc Endosc Percutan Tech 20:e117–e122CrossRefPubMedGoogle Scholar
  4. 4.
    Mitchell J, Siperstein A, Milas M, Berber E (2011) Laparoscopic resection of abdominal paragangliomas. Surg Laparosc Endosc Percutan Tech 21(1):e48–e53. doi: 10.1097/SLE.0b013e31820ad532 CrossRefPubMedGoogle Scholar
  5. 5.
    Hwang J, Shoaf G, Uchio EM, Watson J, Pacak K, Linehan WM, Walther MM (2004) Laparoscopic management of extra-adrenal pheochromocytoma. J Urol 171:72–76CrossRefPubMedGoogle Scholar
  6. 6.
    Wang J, Li Y, Xiao N, Duan J, Yang N, Bao J, Li Y, Mi J (2014) Retroperitoneoscopic resection of primary paraganglioma: single-center clinical experience and literature review. J Endourol 28:1345–1351CrossRefPubMedGoogle Scholar
  7. 7.
    Nozaki T, Iida H, Morii A, Fujiuchi Y, Okumura A, Fuse H (2013) Laparoscopic resection of adrenal and extra-adrenal pheochromocytoma. J Endourol 27:862–868CrossRefPubMedGoogle Scholar
  8. 8.
    Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526PubMedGoogle Scholar
  9. 9.
    Walz MK, Alesina PF, Wenger FA, Koch JA, Neumann HP, Petersenn S, Schmid KW, Mann K (2006) Laparoscopic and retroperitoneoscopic treatment of pheochromocytomas and retroperitoneal paragangliomas: results of 161 tumors in 126 patients. World J Surg 30:899–908CrossRefPubMedGoogle Scholar
  10. 10.
    Barczynski M, Konturek A, Nowak W (2014) Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg 260:740–747 (discussion 747-748) CrossRefPubMedGoogle Scholar
  11. 11.
    Constantinides VA, Christakis I, Touska P, Meeran K, Palazzo F (2013) Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience. Surg Endosc 27:4147–4152CrossRefPubMedGoogle Scholar
  12. 12.
    O’Riordain DS, Young WF Jr, Grant CS, Carney JA, van Heerden JA (1996) Clinical spectrum and outcome of functional extraadrenal paraganglioma. World J Surg 20:916–921 (discussion 922) CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Takashige Abe
    • 1
    Email author
  • Ataru Sazawa
    • 2
  • Toru Harabayashi
    • 3
  • Yuichiro Oishi
    • 1
  • Naoto Miyajima
    • 1
  • Kunihiko Tsuchiya
    • 1
  • Satoru Maruyama
    • 1
  • Hiromi Okada
    • 4
  • Nobuo Shinohara
    • 1
  1. 1.Department of UrologyHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of UrologyObihiro-Kosei General HospitalObihiroJapan
  3. 3.Department of UrologyHokkaido Cancer CenterSapporoJapan
  4. 4.Department of Surgical PathologyHokkaido University HospitalSapporoJapan

Personalised recommendations