Abstract
Introduction
Paragangliomas are the most common extra-adrenal pheochromocytoma. Symptomatic and growing tumors demand surgical extirpation. Minimally invasive techniques allow surgeons to perform the procedure without wide exposure and mobilization of intra-abdominal organs. To our knowledge, we present the fourth case of robotic excision of a large retroperitoneal paraganglioma.
Materials and methods
An 18-year-old unmarried female presented with occipital headache for past 3 years. She also had palpitations and sweating. Ultrasound abdomen revealed a presacral mass of 4 × 4 × 3 cm, and on further evaluation, CECT abdomen characterized 5 × 3.2 × 4 cm well-defined heterogenous mass with intense enhancement in retroperitoneum near presacral region. Functional work-up revealed increased normetanephrine of 3723 mcg/dl and metanephrine of 273 mcg/dl. Patient underwent transperitoneal robot-assisted excision of the mass by fourth-generation da Vinci robotic system. After locating the mass of size 7 × 5 × 3 cm in the presacral region, dissection was carried out all around the mass. Intra-operative hypertensive episodes were managed by esmolol infusion. Feeding vessels were identified, clipped and cut. Resected mass was entrapped in specibag and retrieved intact.
Results
Blood loss was around 50 ml and operative duration was 120 min. In the postoperative period, her blood pressure became normal. Patient was discharged on POD 4. Histopathology was confirmatory of paraganlioma.
Conclusion
Presacral tumors, especially those growing anterior, can be successfully removed with the da Vinci robotic system, and this approach can become the standard for manipulation of this kind of tumor irrespective of its size and malignancy.
References
Boneschi M, Erba M, Giuffrida GF, Mattioli A, Miani S (1993) Functioning paraganglioma. Minerva Chir 48:1399–1405
Park JS, Lee KY, Kim JK, Yoon DS (2009) The first laparoscopic resection of extra-adrenal pheochromocytoma using the da Vinci robotic system. J Laparoendosc Adv Surg Tech A 19:63–65
Lehrfeld T, Natale R, Sharma S, Mendoza PJ, Schwab Ii CW, Lee DI (2010) Robot-assisted excision of a retroperitoneal mass between the left renal artery and vein. JSLS 14:447–449
Cochetti G, Cottini E, Barillaro F, Lepri E, Boni A, Pohja S, Mearini E (2014) Robot assisted laparoscopic excision of a paraganglioma: new therapeutic approach. Int Braz J Urol 40(2):279–280
Kang CM, Kim DH, Seok JY et al (2008) Laparoscopic resection of retroperitoneal benign schwannoma. J Laparoendosc Adv Surg Tech A 18:411–416
Ahmed Kamran, Khan Mohammad Shamim, Vats Amit et al (2009) Current status of robotic assisted pelvic surgery and future developments. Int J Surg 7:431–440
Oh JK, Yang MS, Heum Y (2014) Robotic resection of huge presacral tumors—case series and comparison with an open resection. J Spinal Disord Tech 27:E151–E154
Roizen MF, Horrigan RW, Koike M, Eger IE 2nd, Mulroy MF, Frazer B et al (1982) A prospective randomized trial of four anesthetic techniques for resection of pheochromocytoma. Anesthesiology 57:A43
Ramakrishna H (2015) Pheochromocytoma resection: current concepts in anesthetic management. J Anaesthesiol Clin Pharmacol 31(3):317–323
Plouin PF, Chatellier G, Fofol I, Corvol P (1997) Tumor recurrence and hypertension persistence after successful pheochromocytoma operation. Hypertension 29:1133–1139
Ragavan N, Ramesh M, Kandasamy N, Reddy YV (2016) Robot-assisted laparoscopic excision of organ of Zuckerkandl. J Robotic Surg. doi:10.1007/s11701-016-0617-5
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors namely Santosh Kumar, Pragatheeswarane M, Aditya Prakash Sharma, Kshitij Bishnoi, Manjeet Kumar Sharma, Vikas Kumar Panwar, Sameer Sethi declare that we have no conflict of interest in this study.
Funding
This study was not funded by any organization.
Ethical approval
All procedures performed in this patient were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent
Written informed consent was obtained from the patient for publication of this Case Report/any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Rights and permissions
About this article
Cite this article
Kumar, S., Pragatheeswarane, M., Sharma, A.P. et al. Expanding the horizon of robotic surgery to large pelvic paraganglioma. J Robotic Surg 11, 247–250 (2017). https://doi.org/10.1007/s11701-016-0648-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-016-0648-y