title: Laparoscopic resection of retrocaval paraganglioma.
abstract: OBJECTIVE
  Definitive treatment of paraganglioma is by surgical resection. Laparoscopic resection of the paraganglioma presents a unique surgical challenge due to inherent risks associated with excessive catecholamine release during surgical manipulation and variable anatomic presentation. In this report, we present our experience with the laparoscopic resection of the retrocaval paraganglioma.
  
  
  METHODS
  Between October 2001 and November 2007, 2 patients underwent the laparoscopic resection of a retrocaval paraganglioma. In both cases, the tumors were located just behind the inferior vena cava (IVC) without evidence of vessel-wall invasion. The maximum diameter of the tumor was 47 and 44 mm, respectively. There was extrinsic compression of the IVC in an anterior direction by the tumor. To expose the tumor surface completely, the IVC was mobilized medially. Thereafter, we proceeded with dissection of the posterior attachment of the tumor by using a Harmonic Scalpel (Ethicon, Cincinnati, OH). Finally, the tumor and the right adrenal gland were extracted in an endobag.
  
  
  RESULTS
  In both cases, the tumors were successfully removed laparoscopically without the need for conversion or blood transfusion. The operative time was 440 and 195 minutes, respectively. There were no significant postoperative complications.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of the laparoscopic resection of a retrocaval paraganglioma. For the resection of a paraganglioma, in this location, laparoscopy has the advantage of precise visualization, which helps to resect the tumor completely. Laparoscopic resection of a paraganglioma, despite the high level of compression of the IVC, is a feasible, reproducible technique with appropriate preoperative planning.
authors.affiliation: Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan. nozaki0921@yahoo.co.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nozaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Iida
authors.forename: Shinji
authors.initials: S
authors.lastname: Tsuritani
authors.forename: Akiou
authors.initials: A
authors.lastname: Okumura
authors.forename: Akira
authors.initials: A
authors.lastname: Komiya
authors.forename: Hideki
authors.initials: H
authors.lastname: Fuse
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011859:Radiography; D014682:Vena Cava, Inferior