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Posterior Retroperitoneoscopic Resection of Extra-adrenal Paraganglioma Located in the Aorto-caval Space

Abstract

Background

The posterior retroperitoneoscopic adrenalec tomy has several advantages compared with the transperitoneal approach such as a shorter and more direct route to the target organ, no breach of the intraperitoneal space, and no required retraction of the adjacent organs. It also is a safe procedure with a short learning curve.1,2,3,4,5 This report presents a challenging case of an extra-adrenal paraganglioma located in the aorto-caval space and managed using the retroperitoneal approach.

Methods

A 39-year-old man was placed in the prone jackknife position, and three incisions were made in the right posterior abdominal wall for placement of the laparoscopic ports. The retroperitoneal space was entered with diathermy and blunt finger dissection, and retropneumoperitoneum was achieved with carbon dioxide insufflation pressure up to 18 mmHg. After identification of the right kidney and vessels, the tumor was meticulously dissected and excised with an energy device. The specimen was removed using a laparoscopic specimen retrieval bag, and the port sites were closed in layers.

Results

The operative time was 130 min, and the total blood loss was 30 ml. The tumor was diagnosed as a moderately differentiated extra-adrenal paraganglioma. The Von Hippel-Lindau gene mutation was detected using next-generation sequencing.

Conclusions

The posterior retroperitoneoscopic approach is a safe, feasible, and effective method for excising an extra-adrenal paraganglioma even in the aorto-caval space. The authors suggest that this procedure is a useful surgical option for treatment of an aorto-caval paraganglioma for selected patients and by experienced surgeons.

References

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    Walz MK. Minimally invasive adrenal gland surgery: transperitoneal or retroperitoneal approach? Chirurg. 2012;83:536–45.

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    Lee CR, Walz MK, Park S, et al. A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol. 2012;19:2629–34.

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    Chai YJ, Kwon H, Yu HW, et al. Systematic review of surgical approaches for adrenal tumors: lateral transperitoneal versus posterior retroperitoneal and laparoscopic versus robotic adrenalectomy. Int J Endocrinol. 2014. https://doi.org/10.1155/2014/918346

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    Walz MK, Metz KA, Gorges R, et al. Endoscopic excision of extra-adrenal pheochromocytomas (paragangliomas). Chirurg. 2000;71:1504–8.

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    Xu W, Li H, Ji Z, et al. Comparison of retroperitoneoscopic versus transperitoneoscopic resection of retroperitoneal paraganglioma: a control study of 74 cases at a single institution. Medicine. 2015;94:e538.

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Author information

Correspondence to Cho Rok Lee MD.

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Supplementary material 1 (MP4 286858 kb)

Supplementary material 1 (MP4 286858 kb)

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Kang, S., Kandil, E., Kim, M.J. et al. Posterior Retroperitoneoscopic Resection of Extra-adrenal Paraganglioma Located in the Aorto-caval Space. Ann Surg Oncol 25, 963 (2018) doi:10.1245/s10434-017-6285-5

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