Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Department of Surgery-Oncology, Tulane University College of Medicine, New Orleans, LA, USA.
Ann Surg Oncol. 2018 Apr;25(4):963. doi: 10.1245/s10434-017-6285-5. Epub 2018 Jan 12.
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.15 This report presents a challenging case of an extra-adrenal paraganglioma located in the aorto-caval space and managed using the retroperitoneal approach.
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.
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.
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.
与经腹腔途径相比，后腹腔镜肾上腺切除术具有几个优势，例如到达靶器官的路径更短、更直接，不会破坏腹腔内空间，也不需要牵拉相邻器官。它也是一种安全的手术，学习曲线较短。15 本报告介绍了一例位于腹主动脉-腔静脉间隙的肾上腺外副神经节瘤的挑战性病例，采用后腹腔镜入路进行处理。
一名 39 岁男性患者取俯卧折刀位，在右后腹壁行 3 个切口以放置腹腔镜端口。用电灼和钝性手指分离进入后腹膜间隙，并通过二氧化碳注入使腹膜后间隙充气，充气压力高达 18mmHg。在识别右肾和血管后，仔细分离肿瘤并使用能量装置切除。使用腹腔镜标本取出袋取出标本，并分层关闭端口部位。
手术时间为 130 分钟，总失血量为 30 毫升。肿瘤被诊断为中度分化的肾上腺外副神经节瘤。使用下一代测序检测到 Von Hippel-Lindau 基因突变。
后腹腔镜入路是一种安全、可行且有效的方法，即使在腹主动脉-腔静脉间隙，也可用于切除肾上腺外副神经节瘤。作者认为，对于选定的患者和有经验的外科医生来说，该手术是治疗腹主动脉-腔静脉副神经节瘤的一种有用的手术选择。
