Retroperitoneal Paraganglioma Resected Through the Posterior Retroperitoneoscopic Approach

Abstract

Background: Paragangliomas are rare neuroendocrine tumors arising from neural crest cells. Open exploration and resection are the standard surgical management of retroperitoneal paragangliomas. However, at select centers, both laparoscopic transabdominal and posterior retroperitoneoscopic resection of retroperitoneal paragangliomas have been found to be feasible and safe.1–6 The posterior retroperitoneoscopic approach may have shorter operative time, more direct exposure, less pain, and faster patient recovery than both the open and laparoscopic transabdominal approaches. Methods: The aim of this video is to provide detailed instruction of endoscopic paraganglioma resection through the retroperitoneoscopic approach. Results: The diagnosis of paraganglioma is established by biochemical evaluation and preoperative imaging. The surgical approach uses three incisions in the back, using two 5 mm ports and one central 12 mm port. The retroperitoneal space is developed by blunt dissection and enhanced by CO2 insufflation to 25–30 mmHg. The tumor is carefully dissected and surrounding retroperitoneal structures are preserved. In the current case, the retroperitoneoscopic approach avoided a hostile abdomen because of multiple previous intraabdominal procedures, such as cholecystectomy, appendectomy, hysterectomy, and salpingo-oophorectomy. Conclusions: The posterior retroperitoneoscopic resections of retroperitoneal paraganglioma are feasible and safe. In our experience, the operative time is shorter, with reduced postoperative pain and hospital stay versus the open and laparoscopic transabdominal approaches. It is particularly useful in patients with previous abdominal surgery with the potential of significant adhesions. The cosmetic outcome is excellent. T. S. and T. C. declare that there is no conflict of interests regarding the publication of this article. Runtime of video: 8 mins 26 secs