Burttet Lucas Medeiros, Abreu Fernando Jahn da Silva, Varaschin Gabrielle Aguiar, Silva Brasil, Berger Milton
Serviço de Urologia - Hospital de Clínicas de Porto Alegre, RS, Brasil.
Int Braz J Urol. 2017 Sep-Oct;43(5):997. doi: 10.1590/S1677-5538.IBJU.2016.0465.
Ganglioneuromas are rare benign neoplasms of the sympathetic nervous system. We describe the case of an incidentally found ganglioneuroma in a woman. To our knowledge this is the first described case of robotic excision of a retroperitoneal ganglioneuroma.
A 41-year-old female had an incidental retroperitoneal mass found during a routine US. CT scan and MRI showed an 8.3cm homogeneous mass, adjacent to left kidney upper pole, with peripheral contrast enhancement. Metabolic tests were normal. Patient was positioned in a left flank position and five ports were introduced transperitoneally. A 4-arm Da Vinci SI was docked at a 45º angle to the table. Lesion was dissected along with left adrenal gland, beginning at the left renal hilum and proceeding cephalad.
Operating time was 325min and blood loss was 50ml. Patient was discharged after 72hours. There were no post-operative complications. Pathology showed ganglionic cells with neural tissue, and normal adrenal.
Ganglioneuromas rare benign tumors originating from neural crest and typically affect young adults. Most frequent locations are posterior mediastinum, retroperitoneum and adrenal gland. As in this case, ganglioneuromas are usually silent, slow growing tumors discovered incidentally or by mass effect. US and CT imaging may suggest the diagnosis while MRI findings can be specific for ganglioneuroma. Percutaneous biopsy is an option. Although benign, usually requires surgical excision for treatment.
Our case shows that a robotic approach is feasible and allows for meticulous and safe dissection of vascular structures, facilitating adequate hemostasis while maintaining oncological principles.
神经节神经瘤是交感神经系统罕见的良性肿瘤。我们描述了一名女性偶然发现神经节神经瘤的病例。据我们所知，这是首例经机器人手术切除腹膜后神经节神经瘤的病例。
一名41岁女性在常规超声检查时偶然发现腹膜后肿块。CT扫描和MRI显示一个8.3厘米的均匀肿块，毗邻左肾上极，周边有对比增强。代谢检查正常。患者取左侧卧位，经腹腔置入5个端口。一台四臂达芬奇SI机器人以45°角对接于手术台。从左肾门开始并向上，连同左肾上腺一起切除病变。
手术时间为325分钟，失血50毫升。患者在72小时后出院。无术后并发症。病理显示神经节细胞伴神经组织，肾上腺正常。
神经节神经瘤是起源于神经嵴的罕见良性肿瘤，通常影响年轻人。最常见的部位是后纵隔、腹膜后和肾上腺。如本病例所示，神经节神经瘤通常无症状，生长缓慢，多偶然发现或因占位效应而被发现。超声和CT成像可提示诊断，而MRI表现对神经节神经瘤具有特异性。可选择经皮活检。虽然是良性肿瘤，但通常需要手术切除进行治疗。
我们的病例表明，机器人手术方法是可行的，能够精细、安全地解剖血管结构，有助于充分止血，同时遵循肿瘤学原则。
