Safe laparoscopic resection of a giant schwannoma in the retroperitoneum using a fluorescent ureteral stent: a case report

Abstract

Schwannomas that occur in the retroperitoneal cavity are rare. We herein report a patient who underwent safe laparoscopic resection by using a preoperative 3D computed tomography (CT) image and a fluorescent ureteral stent during the surgery. A 47-year-old man presented with left lower abdominal pain. CT showed a 10-cm continuous retroperitoneal tumor originating at the third lumbar nerve in the lower left abdomen. Schwannoma was suspected. We underwent laparoscopic resection of the tumor guided by 3D images obtained preoperatively. A fluorescent ureteral stent was implanted during the surgery to improve visibility and protect the left ureter. The resection was completed without injury of other organs and vessels. The patient was discharged on postoperative Day 5. By performing a preoperative simulation using 3D CT images, we could anticipate the anatomical findings and easily identify them intraoperatively. In addition, the fluorescent ureteral stent provided visual support, thereby contributing to safe surgery.

Laparoscopic surgery combined with the double-J tube implantation for the rare cystic-solid schwannoma of seminal vesicle: A Case Report and Literature Review

“…It has been reported that prophylactic placement of double-J tube is widely used in pelvic floor surgery (Urology, Anorectum, and Gynecology), which can better expose the ureter and reduce the risk of ureteral injury. [ 19 , 25 , 26 ] Thus, it is recommended that double-J tubes be placed prophylactically before the operation to improve the surgical effect.…”

“…In our cases, preoperative MR revealed that the tumor was near the ureter in this case, which was confirmed by intraoperative observation. Therefore, combined with the experience of pelvic surgery in urology, Anorectum and Gynecology, [ 19 , 25 , 26 ] laparoscopic resection combined with catheter placement under cystoscope was chosen. Before laparoscopy, the double-J catheter was placed in the ureter with a cystoscope.…”

“…[22] The cells in the area of Antoni A were closely arranged and showed a whirlpool or onion skinlike structure. [22,24] The cells in the Antoni B area were arranged loosely and disorderly, with many vacuoles or watery liquid, forming microcapsules or large cavities (19). The degree of cytological atypia was not obvious.…”

“…Use a cystoscope to keep a double-J tube in the ureter before opening or laparoscopic surgery to protect the ureter and show the ureter clear during surgery. [ 19 ] Thus, it can reduce the difficulty of the operation and postoperative complications.…”