Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu, Japan.
Medical Education Development Center, Gifu University, Gifu, Japan.
World J Surg Oncol. 2022 Jan 4;20(1):3. doi: 10.1186/s12957-021-02483-0.
We report two rare cases of retroperitoneal schwannoma completely resected by a laparoscopic medial-retroperitoneal approach aided by virtual navigation. Three-dimensional images have been used in liver and lung surgery, but there are few prior reports on retroperitoneal surgery.
These two case reports are of a 60-year-old man and a 40-year-old man with asymptomatic retroperitoneal schwannoma. In both cases, the tumors were located in the right renal hilum and were close to the duodenum, right ureter, and inferior vena cava. Simulation using three-dimensional images was performed before surgery, and a medial-retroperitoneal approach was performed to secure a wide surgical field. During the operation, we confirmed the location of the main feeder and the relationship between the tumor and organs with those shown on the three-dimensional images and performed total laparoscopic resection.
The medial-retroperitoneal approach provides operative safety. Preoperative simulation and intraoperative navigation with three-dimensional images, which can be freely rotated and interactively visualized from any angle, are useful methods to enhance the surgeon's understanding of a patient's specific anatomy and are especially effective when resecting a retroperitoneal tumor that is located in an anatomically deep and complex location.
我们报告两例罕见的腹膜后神经鞘瘤病例，这些肿瘤完全通过腹腔镜内侧腹膜后入路切除，该入路得到了虚拟导航的辅助。三维图像已用于肝脏和肺部手术，但在腹膜后手术中鲜有报道。
这两例病例报告分别为一名 60 岁男性和一名 40 岁男性，他们均患有无症状的腹膜后神经鞘瘤。在这两个病例中，肿瘤均位于右肾门，靠近十二指肠、右输尿管和下腔静脉。手术前进行了三维图像模拟，并采用内侧腹膜后入路以确保获得宽阔的手术视野。在手术过程中，我们通过三维图像确认了主要供血动脉的位置以及肿瘤与器官之间的关系，并进行了完全腹腔镜切除。
内侧腹膜后入路提供了手术安全性。术前模拟和术中使用三维图像导航，这些图像可以从任何角度自由旋转和互动可视化，是增强外科医生对患者特定解剖结构理解的有用方法，对于切除位于解剖深处且复杂位置的腹膜后肿瘤尤其有效。
