title: Laparoscopic resection of paraaortic/paracaval neurogenic tumors: surgical outcomes and technical tips.
abstract: Due to variations in location and size, laparoscopic surgery for paraaortic or paracaval neurogenic tumors is challenging. We evaluated the surgical outcomes, as well as surgical tips and tricks.
  
  
  
  Between 2000 and 2015, 25 procedures were performed in 24 patients. One patient underwent second surgery due to the recurrence of paraganglioma. Data were collected on the tumor diameter, tumor location, perioperative outcomes, pathology, and last-known disease status. Regarding the operative procedures, we reviewed the operative charts or videos to identify surgical tips and tricks.
  
  
  
  The median tumor diameter was 5.0 cm (range 1.5-10). The tumor location was suprahilar in 10, hilar in 6, and infrahilar in 9 cases. Regarding the approach, a transperitoneal approach was selected in 24 cases and retroperitoneal approach in 1. The median operative time and blood loss were 208 min (range 73-513) and 10 mL (range 0-1020), respectively. No patient required blood transfusion or conversion to open surgery. Pathological examination revealed paraganglioma in 12, ganglioneuroma in 7, and schwannoma in 6 cases. At the last follow-up, 23 patients were free of disease, while one patient developed metastatic multiple recurrence of paraganglioma 54 months after the second laparoscopic surgery. A review of the surgical records revealed several tips and tricks, including taping the vena cava/renal vein (n = 2) being helpful for detaching a retrocaval tumor from these great vessels, or rotating the kidney to provide a favorable operative view of tumors behind the renal hilum (n = 2). In recent cases, 3D-CT was helpful for preoperative planning.
  
  
  
  Laparoscopic resection of paraaortic or paracaval neurogenic tumors is feasible in experienced hands. Surgeons should be familiar with detaching maneuvers around great vessels and the mobilization of adjacent organs. Careful preoperative planning is mandatory.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan. takataka@rf6.so-net.ne.jp.
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Urology, Obihiro-Kosei General Hospital, Obihiro, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.affiliation: Department of Urology, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Oishi
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyajima
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Maruyama
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Okada
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D061887:Conversion to Open Surgery; D005260:Female; D005729:Ganglioneuroma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007668:Kidney; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D010235:Paraganglioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014743:Videotape Recording; D055815:Young Adult
keywords: Laparoscopic surgery; Neurogenic tumor; Paraganglioma