Retroperitoneoscopic Resection of Retroperitoneal Mass · Retroperitoneal approach for the...
Transcript of Retroperitoneoscopic Resection of Retroperitoneal Mass · Retroperitoneal approach for the...
Hye Kyung Chang, JungHye Kyung Chang, JungHye Kyung Chang, JungHye Kyung Chang, Jung----Tak Oh, Seung Hoon Choi, Seok Joo HanTak Oh, Seung Hoon Choi, Seok Joo HanTak Oh, Seung Hoon Choi, Seok Joo HanTak Oh, Seung Hoon Choi, Seok Joo Han
Division of Pediatric Surgery, Department of Surgery,Division of Pediatric Surgery, Department of Surgery,Division of Pediatric Surgery, Department of Surgery,Division of Pediatric Surgery, Department of Surgery,Yonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineYonsei University College of Medicine
Retroperitoneoscopic Resection of Retroperitoneoscopic Resection of Retroperitoneoscopic Resection of Retroperitoneoscopic Resection of Retroperitoneal MassRetroperitoneal MassRetroperitoneal MassRetroperitoneal Mass
BackgroundBackgroundBackgroundBackground
PurposePurposePurposePurpose
Retroperitoneoscopic SurgeryRetroperitoneoscopic SurgeryRetroperitoneoscopic SurgeryRetroperitoneoscopic Surgeryminimal invasive surgery for retroperitoneal organs
developed during last decade
Retroperitoneoscopy vs. LaparoscopyRetroperitoneoscopy vs. LaparoscopyRetroperitoneoscopy vs. LaparoscopyRetroperitoneoscopy vs. Laparoscopy
preferred tool for the cases of retroperitoneal pathology
advantage of direct route without passage through the abdominal cavityvs. transperitoneal route of wider and more familiar peritoneal chamber
report of a case of a retroperitoneoscopically removed retroperitoneal mass in 7-year-old girl who has V-P shung d/t
hydrocephalus
7-year-old girl(19kg : 3 percentile, 123 cm : 25-50 percentile)
an incidentally found retroperitoneal mass
Historychoroid plexus papilloma with hydrocephalusreceived a few times of operation for V-P shunts
due to uncontrolled hydrocephalusand malfunction of V-P shunt catheter 7 years ago
Case PresentationCase PresentationCase PresentationCase Presentation
Preop. Abd. CTPreop. Abd. CTPreop. Abd. CTPreop. Abd. CT
Preop. Brain CTPreop. Brain CTPreop. Brain CTPreop. Brain CT
well defined mass of6 x 5 cm in size inright retroperitonealspace
Preop. PETPreop. PETPreop. PETPreop. PET
• wellwellwellwell----defineddefineddefineddefined hypoechoichypoechoichypoechoichypoechoic massmassmassmass• compression of Rt.compression of Rt.compression of Rt.compression of Rt. kidneykidneykidneykidney and and and and vessel by the massvessel by the massvessel by the massvessel by the mass• multiplemultiplemultiplemultiple brightbrightbrightbright echo inside the echo inside the echo inside the echo inside the mass : r/omass : r/omass : r/omass : r/o calcificationcalcificationcalcificationcalcification
IMP:IMP:IMP:IMP: R/OR/OR/OR/O neurogenic tumor, neurogenic tumor, neurogenic tumor, neurogenic tumor, retroperitoneumretroperitoneumretroperitoneumretroperitoneum
Preop. Abd. U/SPreop. Abd. U/SPreop. Abd. U/SPreop. Abd. U/S
retroperitoneal approach vs. transperitoneal approachretroperitoneal approach vs. transperitoneal approachretroperitoneal approach vs. transperitoneal approachretroperitoneal approach vs. transperitoneal approach
1) possible intraperitoneal adhesiondue to previous V-P shunt operations
2) benign character of the retroperitoneal lesion on imaging studiessuch as ultrasonogram, CT scan, and PET scan
3) disturbance of V-P shunt function with transperitoneal approach
4) no need for restriction of postop. oral intake with retroperitoneal approach
Retroperitoneoscopic resectionRetroperitoneoscopic resectionRetroperitoneoscopic resectionRetroperitoneoscopic resection
Lt. lateral position with flexion of Lt. flank
post. wound extension for mass removalno drainage inserted
total operating time : 420 minutes
ovoid solid pinkish yellow mass, measuring 5x3.5x4cmpathologic diagnosis was ganglioneuromaganglioneuromaganglioneuromaganglioneuroma
Post. Ant.
four 5mm trocas on Rt. flankfor operator, camera & assistant
Abd. CT f/u on POD #5Abd. CT f/u on POD #5Abd. CT f/u on POD #5Abd. CT f/u on POD #5
ConclusionConclusionConclusionConclusion
I.I.I.I. Retroperitoneoscopic resection of retroperitoneal Retroperitoneoscopic resection of retroperitoneal Retroperitoneoscopic resection of retroperitoneal Retroperitoneoscopic resection of retroperitoneal mass is an acceptable procedure in pediatrics.mass is an acceptable procedure in pediatrics.mass is an acceptable procedure in pediatrics.mass is an acceptable procedure in pediatrics.
II.II.II.II. Retroperitoneal approach for the retroperitoneal Retroperitoneal approach for the retroperitoneal Retroperitoneal approach for the retroperitoneal Retroperitoneal approach for the retroperitoneal lesions is more feasible with its direct route than lesions is more feasible with its direct route than lesions is more feasible with its direct route than lesions is more feasible with its direct route than transperitoneal approach, especially for previous transperitoneal approach, especially for previous transperitoneal approach, especially for previous transperitoneal approach, especially for previous intraabdominal surgery.intraabdominal surgery.intraabdominal surgery.intraabdominal surgery.
III.III.III.III. Resection of benign retroperitoneal pathologyResection of benign retroperitoneal pathologyResection of benign retroperitoneal pathologyResection of benign retroperitoneal pathologymay be performed easily in good result with full may be performed easily in good result with full may be performed easily in good result with full may be performed easily in good result with full
awareness of retroperitoneal anatomy.awareness of retroperitoneal anatomy.awareness of retroperitoneal anatomy.awareness of retroperitoneal anatomy.