Page 3 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, May-August 2009;2(2):1-5
Laparoscopic Management of Retroperitoneal Masses: Our Experience and Literature Review

Laparoscopic Management of Retroperitoneal

Masses: Our Experience and Literature Review

Matvey Tsivian, A Ami Sidi, Alexander Tsivian
Department of Urologic Surgery, E Wolfson Medical Center, Holon and Sackler Faculty of Medicine
Tel Aviv University, Tel Aviv, Israel
Correspondence: Alexander Tsivian, Department of Urologic Surgery, E Wolfson Medical Center, POB 5, Holon, Israel
Phone: +972-3-5028653, Fax: +972-3-5028199, E-mail: atsivian@hotmail.com

Abstract inadequate. The advantages of laparoscopic surgery over open
Background: Retroperitoneal growths often require surgical exploration approach may be exploited in this setting with no compromise
for diagnostic and/or therapeutic purposes. Here in, we present our of the outcomes.
experience in laparoscopic management of retroperitoneal masses Herein we present our experience in laparoscopic manage-
and review the literature to assess the feasibility of a minimally invasive ment of retroperitoneal masses and review the literature.
approach in this setting.
Method: In the last 4 years 8 consecutive patients, aged 46 to 73
years, underwent laparoscopic surgery for isolated retroperitoneal MATERIAL AND METHODS
masses at our institution. Medical records were reviewed collecting
data regarding clinical presentation, dimensions of the finding, pathology, In the last 4 years 8 consecutive patients, aged 46 to 73 years,
whether a preoperative biopsy was performed and its results, underwent laparoscopic surgery for isolated retroperitoneal
procedure performed (excision versus incisional biopsy), operative masses by a single surgeon (AT) in our institution. Medical
times, estimated blood loss, complications, hospital stay and records of these patients were reviewed. We collected data
follow-up.
regarding clinical presentation, dimensions of the finding,
Results: All procedures were successfully completed laparoscopically pathology, whether a preoperative biopsy was performed and
with no conversions. Mean operative time was 131 minutes. Blood its results, procedure performed (excision versus incisional
loss was 0-200 mL and blood transfusions were not required. One
bowel injury was repaired intraoperatively; postoperative course was biopsy), operative times, estimated blood loss, concomitant
uneventful in all cases. Hospital stay ranged from 2 to 7 days. Final procedures, complications, hospital stay and follow-up.
pathology was local recurrence of Renal cell carcinoma in 3 cases, Lesion dimensions were registered using the largest
1 lymphoma, 1 sarcoma, 1 schwannoma and 2 retroperitoneal cysts. dimension from imaging studies. Operative times were recorded
With an average follow-up of over 2 years there are no recurrences. as skin-to-skin times; in 2 out of 8 cases additional surgical
Conclusion: Laparoscopic approach is a feasible approach in selected procedures were performed simultaneously and their operative
patients with retroperitoneal masses. In our experience, laparoscopy times were subtracted from total.
offers a viable and oncologically radical option with excellent results Standard surgical technique was used for laparoscopic
and low morbidity. This minimally invasive approach is likely to become
more common practice as the experience grows and new technologies approach. In a full flank position, lesion side upwards,
become available. pneumoperitoneum was established by open technique.
Keywords: Retroperitoneal, laparoscopy, tumor. Additional 3 trocars were placed in the upper abdomen. The
retroperitoneal space was accessed by colon mobilization along
the line of Toldt and the mass was identified. The finding was
INTRODUCTION
then dissected from adjacent structures with accurate
Laparoscopy is now widely used in urological surgery. As hemostasis. The mass was then detached with adequately wide
surgical experience grows and more urologists acquire expertise margins and extracted in an Endobag through an additional
in laparoscopic approach, possible indications for this procedure incision in the lower abdomen (3 cases) or through an extension
expand. This is the case of retroperitoneal masses and their of a port incision.
management with a minimally invasive surgical technique. The literature was reviewed using PubMed/Medline
Retroperitoneal growths often require surgical exploration for database and keywords ‘laparoscopy’ or ‘laparoscopic’,
diagnostic and/or therapeutic purposes since in many cases ‘retroperitoneal’ or ‘retroperitoneum’; lymph node dissections
imaging is inconclusive and biopsy, when feasible, can be and adrenal surgery were excluded. Relevant abstracts and

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