V11-07: Successful Excision of Retrocaval Tumor by Retroperitoneoscopic Approach in Two Patients

Video

Introductions and Objectives
Laparoscopic excision of a retroperitoneal tumor located dorsal to the inferior vena cava (IVC) is challenging. It is often difficult to manage such tumors located superior to the kidney by transperitoneal approach because of intraabdominal organs and IVC. We show the video of successful excision in two patients with a retrocaval tumor using the retroperitoneoscopic approach.

Methods
Patient No.1 was a 43-year-old woman with repeated episodes of hypertensive attack and the high serum noradrenalin level. CT and MRI revealed a 35?~20?~35-mm tumor dorsal to the IVC at the level of the superior mesenteteric artery (SMA). The median border of the tumor extended beyond the SMA. MIBG scintigraphy was positive. Patient No. 2 was a 53-year-old woman with an incidentally found retrocaval tumor without any endocrinological abnormal findings. CT and MRI showed a 42?~30?~37-mm tumor dorsal to the IVC at the level of celiac arterial trunk. MIBG scintigraphy was negative.

Results
In both patients, four trocars including a camera port were placed and the tumors were excised successfully without complications. Operating time was 168 minutes and 137 minutes, respectively. Postoperative course was uneventful in both patients. Pathologically, the tumor was paraganglioma in patient No.1 and schwannoma in patient No. 2.

Conclusions
The relatively large tumor located dorsal to the IVC can be successfully excised by the retroperitoneal endoscopic approach. By widely opening Gerata?fs (lateroconal) fascia and making a wide space superior and posterior to the kidney, a sufficient surgical view and space to operate the retrocaval tumor was obtained without being hindered by intra-abdominal organs. The retroperitoneoscopic surgical excision is feasible and safe for the management of retrocaval tumors.

Funding: None