Retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuromas: our technique and clinical outcomes

Abstract

Objective: 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.

Rich Surface Oxygen Vacancies of MnO2 for Enhancing Electrocatalytic Oxygen Reduction and Oxygen Evolution Reactions

“…The crystallographic structure of the manganese oxides can be easily modulated through the reactant ratio of MnSO 4 to KMnO 4 according to the reported works. [ 21,32,33 ]…”

Retroperitoneal approach in a child with ganglioneuroma: points of technique and literature review

“…Concerning the risk of recurrence, Spinelli et al [20] did not experience any recurrences during follow-up period in surgically treated pediatric patients. Due to the benign nature of GN, radiotherapy or adjuvant chemotherapy is not indicated [1,19,21,22]. Even if follow-up protocol after complete excision is not clearly reported in literature, a regular follow-up is suggested to exclude local recurrences [1], especially when resection was not complete [11].…”

“…Due to the benign nature of GN, radiotherapy or adjuvant chemotherapy is not indicated [1,19,21,22]. Even if follow-up protocol after complete excision is not clearly reported in literature, a regular follow-up is suggested to exclude local recurrences [1], especially when resection was not complete [11].…”

“…Ganglioneuroma (GN) is a rare, benign, differentiated neurogenic tumor arising mainly from primordial neural crest [1] affecting the pediatric age group. The median age at diagnosis is about 7 years old [2].…”

Retroperitoneal ganglioneuroma presenting as an obstructive pyelonephritis: a case report

“…On CT, it is a hypodense mass with a density between 20 and 40 HU and delayed contrast enhancement in a range of 10–20 HU. GN appears homogeneous and can be sometimes heterogeneous with circumscribed or spotted calcifications (in 20% of the patients) [ 9 ]. On MRI, T 1 -weighted images show a low or intermediate signal intensity, whereas T 2 -weighted images show a heterogeneous intermediate or high-signal intensity.…”