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Laparoscopic treatment of paracaval paraganglioma

A 41-year-old man presented with a 2.5cm, paracaval, sub-duodenal mass incidentally discovered during an abdominal ultrasound. The patient suffered from occasional hypertensive crises. Clinical and laboratoristic evalutation suggested the diagnosis of catecholamine-secreting tumor, i.e., paraganglioma. After an adequate preoperative antiadrenergic treatment, the lesion was easily removed by using a laparoscopic approach.

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Laparoscopic treatment of paracaval paraganglioma

作者群

G Perigli, F Cianchi, D Romano

摘要

A 41-year-old man presented with a 2.5cm, paracaval, sub-duodenal mass incidentally discovered during an abdominal ultrasound. The patient suffered from occasional hypertensive crises. Clinical and laboratoristic evalutation suggested the diagnosis of catecholamine-secreting tumor, i.e., paraganglioma. After an adequate preoperative antiadrenergic treatment, the lesion was easily removed by using a laparoscopic approach.

關鍵字

paracaval, sub-duodenal mass, abdominal ultrasound, catecholamine-secreting tumor, paraganglioma, laparoscopy

媒體類型

手術影片

期間

07'47''

刊物

2008-03

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Mar 2008;8(03).
URL: http://www.websurg.com/doi-vd01en2295.htm

Laparoscopic treatment of paracaval paraganglioma

1. Case presentation 00'15''

A 41-year-old man presented with a 2.5cm paracaval subduodenal mass incidentally discovered during abdominal ultrasound. The patient had suffered from occasional hypertensive crises in the past. Clinical and laboratory evaluations suggested the diagnosis of a catecholamine secreting tumor, i.e., a paraganglioma. After an adequate preoperative anti-adrenergic treatment, the plan was to remove this lesion by laparoscopy. Further imaging by CT scan shows a solid 2.5cm mass located below the inferior knee of the duodenum and anteriorly to the vena cava. The lesion presents an early contrast enhancement. The positron emission tomography confirms intense uptake in the same area.

2. Trocar placement 01'09''

The patient is placed supine in a 30° left tilt position.

3. Case commences with initial peritoneal dissection 01'13''

One optical and three operative trocars are arranged similarly to the laparoscopic right hemicolectomy. At laparoscopy, the mass is immediately evident just below the duodenum. The peritoneum is therefore divided as far as the right colic vessels. These vessels represent the limit of the dissection and are themselves preserved. The peritoneal dissection is continued circumferentially to the mass by using the Harmonic scalpel. This ensures precise hemostatic dissection. Dissection is then performed into a deeper plane until the tumor capsule becomes apparent.

4. Peritumoral dissection 03'45''

Dissection of the tumor from the duodenum is now being completed. It’s important that any vessels emerging from the retroperitoneal space and sympathetic chain are prepared and divided. Since the tumor has a widespread vascularization, every single blood vessel must be accurately coagulated or ligated.

5. Deep dissection 04'20''

Some mild hemorrhage is almost inevitable. The right ureter with its typical peristaltic movements appears at the back of the operative field. It’s important to be aware of this and ensure that no iatrogenic injuries occur. Slight bleeding often requires the use of a hemostatic sponge which helps to keep the operative field clean. Patient dissection around the tumor is necessary to ensure that all feeding vessels can be controlled. By lifting the mass, the posterior dissection is completed by using clips as well as the Harmonic scalpel.

6. Resection of lesion 06'28''

Once the dissection is complete, the lesion is placed in a bag that can be withdrawn through the upper left port. The operation is concluded with the placement of a small hemostatic pad and a tubular drain to the operation site. The macroscopic appearance of the specimen as well as the microscopic and immuno-histochemical analyses confirm the preoperative diagnosis of paraganglioma.