機械手臂輔助腹膜後切除脊椎旁腫瘤：特殊病例報告與文獻回顧

謝佳駤¹、蔡易辰¹、廖以莊²、宋冠嶔³、黃冠華¹、邱文祥⁴

台南永康奇美醫院 外科部 泌尿科¹；台南永康奇美醫院 病理部²；台南永康奇美醫院 外科部 神經外科³；台北新光吳火獅紀念醫院 泌尿科⁴

Robotic-assisted Retroperitoneal Approach Resection of a Paraspinal Tumor - A Rare Case Report and Literature Review

Chia-Chih Hsieh¹、I-Chen Tsai¹、I-Chuan Liao²、Kuan-Chin Sung³、Steven K. Huang¹、Allen W.Chiu⁴

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan;

³Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴Division of Urology, Department of Surgery, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan

Purpose:

The resection of paraspinal or retroperitoneal tumors adjacent to the lumbar spine presents significant challenges when performed via minimally invasive techniques. Traditionally, literature describes an open anterior retroperitoneal approach to access tumors in this complex region. In this report, we introduce a novel robotic-assisted technique for excising a paraspinal tumor situated in the left prevertebral space at the L4 level, utilizing a lateral retroperitoneal approach to enhance precision and minimize invasiveness.

Case presentation:

We present a case of a 60-year-old male with an incidental finding of a paraspinal tumor. Magnetic resonance imaging identified a well-encapsulated mass measuring 2.7 cm in the left prevertebral space at the L4 level, located between the aorta and psoas muscle, with a presumptive diagnosis of schwannoma. The procedure was jointly performed by a urologic surgeon and a neurosurgeon. An initial cystoscopic placement of a left ureteral catheter was completed, followed by positioning the patient in the right lateral decubitus position with the ipsilateral flank exposed. The da Vinci Xi robotic system provided retroperitoneal access via five ports along the left flank. Neurophysiologic monitoring of the genitofemoral nerve showed no abnormalities, while intraoperative ultrasound localized the tumor and the ureter catheter minimized the risk of iatrogenic injury. The tumor capsule was dissected and resected completely without rupture, and a closed-wound vacuum drainage was placed at the prevertebral site. Immunohistochemical analysis revealed S-100 and SMA positivity, confirming schwannoma with typical Verocay bodies. Postoperative recovery was uneventful, and the patient exhibited no neurological deficits. Ongoing follow-up will monitor for recurrence.

Conclusions:

The tumor in this case was located in a challenging position, yet resection was successfully completed within a very short operative time with the assistance of the da Vinci robotic system via lateral retroperitoneal approach. In selected cases, a robot-assisted retroperitoneal approach offers a minimally invasive alternative for paraspinal tumor resection, providing advantages over conventional methods in safety and reduced invasiveness. Interdisciplinary collaboration and adjunctive technologies, such as intraoperative ultrasound and neurophysiologic monitoring, are recommended to enhance outcomes.