J Korean Surg Soc.  2010 Apr;78(4):253-257. 10.4174/jkss.2010.78.4.253.

Laparoscopic Resection of a 12 cm Sized Retroperitoneal Schwannoma Adjacent to Retroperitoneal Vital Vessels: Are Large Retroperitoneal Schwannomas Not Suitable for the Laparoscopic Approach?

• Cho YH
• Kim DH
• Lee SH
• Son GM
• Lee SH
• Kim HY
• Kim GH
• Park DY
• Kim S

• KMID: 1750739
• DOI: http://doi.org/10.4174/jkss.2010.78.4.253

Abstract

There are a lot of advantages to laparoscopic surgery, including early recovery, less postoperative pain, better cosmesis, shorter hospital stay and an early return to normal activities because of its minimal invasiveness. So, most surgeons have agreed on these points and have accepted the various indications for laparoscopic surgery. Despite these advantages and the recent advances in laparoscopic surgery, there are few cases using the laparoscopic approach for treating retroperitoneal schwannomas. Laparoscopic resection of a large retroperitoneal schwannoma has some difficulties for tumor retraction, dissecting around the large vessels, and removal of the resected tumor. Sometimes these difficulties may cause complications and a lengthened hospital stay. However, if appropriate methods are used, long hospital stay and complication can be prevented while maintaining the advantages of laparoscopic surgery.

Keyword

Schwannomas; Retroperitoneum; Laparoscopic resection

MeSH Terms

Laparoscopy
Length of Stay
Neurilemmoma
Pain, Postoperative

Figure

• 

  Fig. 1 Abdominal CT findings. The image shows a 12×10 cm sized retroperitoneal tumor (A). The horizontal section view demonstrates a well-defined, encapsulated mass that has an internal cystic component. The mass is located adjacent to the superior mesenteric artery and celiac trunk (B). On the coronal section view, the mass was located adjacent to the splenic vein, left renal vein, and abdominal aorta (C).

• 

  Fig. 2 Pathologic findings. Cut surface of resected specimen showed relatively well-circumscribed yellow-white tumor mass without evidence of hemorrhage and necrosis (A). It showed cores of tissue composed of bland spindle cells with fibrotic stroma and S-100 immunostain showed diffuse positivity on spindle cells (B).

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  Fig. 3 Operative findings of laparoscopic resection. After performing omentectomy from the splenic flexure to the mid-transverse colon, the anterior surface of the tumor was exposed (A). The operative findings after completed resection of the tumor from the surrounding tissue (B). After complete resection, we vertically extended the umbilical incision about 3 cm in length to remove the resected tumor (C).

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