後腹腔內視鏡切除神經性腫瘤
何宣瑩, 黃冠華1, 李高漢, 賴韋宏2
奇美醫學中心 外科部 泌尿外科, 泌尿腫瘤科1
戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科2
Retroperitoneal Laparoscopic Resection of Neurogenic Tumor
Hsuan-Ying Ho, Steven Kuan-Hua Huang1, Kau Han Lee, Wei-Hong Lai2
Division of Urology, Department of Surgery, Devision of Uro-Oncology1, Chi Mei Medical Center, Tainan, Taiwan;
Division of Urology2, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital
Purpose: Retroperitoneal laparoscopic resection of retroperitoneal tumor can be challenging due to variations in location, size, and tumor characteristics. We would like to share our experience in retroperitoneoscopic surgery for neurogenic tumor and the experience of using intra-operative neuromonitoring technique.
Materials and Methods: Between June 2014 and December 2015, retroperitoneal laparoscopic resection of retroperitoneal tumor was performed on 10 patients. Three of the 10 patients were pathologically proved Shwannoma. Others include metastatic malignant melanoma, leiomyosarcoma, liposarcoma, cystic lymphangioma, hemangioma, adrenal cortical carcinoma, and pheochromocytoma. Among three patient with Shwannoma, intraoperative neuromonitoring was used in two patients for pre-operative image suggest possible neurogenic tumor. One patient underwent resection of two tumors at the same time.
Results: The median tumor diameter was 6.75 cm (range 4-12). The tumor location: two embedded on right psoas muscle with right L3 root compression, one at lower pole of right kidney with right psoas muscle adhesion, one at retrocaval region. All of the tumors were approached retroperitoneally. The median operative time was 206 min (range 120-300) and blood loss was 33 mL (range 0-100). No patient required blood transfusion. One patient receiving robotic assisted surgery had a conversion to traditional laparoscopic surgery because of malposition of the robot. Pathological examination revealed all schwannoma in 3 cases. During follow-up, there was no tumor recurrence noted.
Conclusion: Retroperitoneal laparoscopic resection of neurogenic tumor is a feasible choice. Combining intraoperative neuromoitoring, we can decrease the risk of neurological complication. When dealing with tumor next to great vessel or location hard to approach, pre-operative planning is necessary.