Abstract
ABSTRACTObjective:To report our experience of retroperitoneoscopic technique in semi-lateral decubitus position for the retroperitoneal nonadrenal ganglioneuromas in 18 patients, and to evaluate its clinical outcomes.Materials and Methods:From January 2012 to May 2016, 18 patients with retroperitoneal nonadrenal ganglioneuromas underwent retroperitoneoscopic resection. With the patients in semi-lateral decubitus position, a 4-port retroperitoneal approach was used. Data were collected on the tumor size, tumor location, perioperative outcomes, pathology, and last-known disease status. We reviewed the operative videos to identify surgical tips and tricks.Results:All procedures were carried out successfully without converting to open surgery. The tumors had an average size of 5.2cm. The mean operative time was 86.5 min, with a mean estimated blood loss of 85.4mL. There were three patients suffering from intraoperative complications. Postoperatively, all patients achieved an uneventful recovery; the mean postoperative hospital stay was 5.5 days. The postoperative pathology revealed to be retroperitoneal ganglioneuromas. With a mean follow-up of 39.5 months, all patients were recurrence free. The review of the operative videos revealed several tips and tricks, including keeping peritoneum and posterior Gerota fascia intact to provide a favorable operative exposure of tumors, and placing the harmonic scalpel through different ports during tumor dissection.Conclusions:With the patient in semi-lateral decubitus position and a 4-port retroperitoneal approach, retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuroma is a feasible, effective, and safe procedure. This approach has distinct advantages including direct access to the tumor, optimal exposure of tumor and less intraperitoneal interference.
Highlights
Ganglioneuromas are rare, benign neurogenic tumors that originate from the neural crest
We report our experience of retroperitoneal laparoscopic resection of nonadrenal retroperitoneal ganglioneuroma in 18 patients and analyze the feasibility and safety of our technique
Ganglioneuromas are tumors of the sympathetic nervous system that arise from the neural crest cells [12]
Summary
Ganglioneuromas are rare, benign neurogenic tumors that originate from the neural crest. Retroperitoneal tumors have traditionally been excised using a standard open technique [47]. Due to advances in laparoscopic instruments and surgical techniques, indications for the laparoscopic approach have been broadened to the retroperitoneal tumors [8,9,10]. Surgical access to the retroperitoneal space is generally achieved by abdominal transperitoneal approach. Reports on the retroperitoneal laparoscopic approach to nonadrenal retroperitoneal tumors are limited [11]. In comparison with transperitoneal laparoscopic surgery, the main advantages of retroperitoneal approach include a faster access to the tumor, requiring little dissection without violating the peritoneal cavity. We report our experience of retroperitoneal laparoscopic resection of nonadrenal retroperitoneal ganglioneuroma in 18 patients and analyze the feasibility and safety of our technique
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