Laparoscopic Resection of Schwannoma in the Anomaly of Obturator Nerve

Novel technical modifications of hand-assisted laparoscopic dissection of a large obturator mass: A case report and literature review

Laparoscopic lateral pelvic tumor dissection (LLPTD) for transobturator tumors may be technically challenging due to the requirement for sufficient operative space. The present study discusses a technique modification with combination of the laparoscopic approach and hand-assisted (HA) open surgery for patients with large obturator masses. LLPTD was performed using the combined approach, defined as HA-LLPTD, with one case treated. According to this technique, a combined working space is constructed based on the outreached laparoscopic space and open extraperitoneal approach, followed by HA-LLPTD. Finally, a literature review was performed to retrospectively evaluate 17 cases of obturator tumors, in terms of tumor type and operative approach. The tumor in the present case was successfully and completely resected, without any obvious intra- and post-operative complications. Based on the literature review, the majority of the cases were benign (~75%) and originated from neurological tissue (~50%). The selection of the operative approach was either open or minimally invasive (50% each). HA-LLPTD allows experienced urological laparoscopic surgeons to safely and completely perform obturator surgery without obstruction of the obturator foramen or formation of intraperitoneal adhesions and associated complications. Therefore, HA-LLPTD may be more useful for transobturator tumor resection compared with the conventional intraperitoneal approach.

Giant Pelvic Schwannoma: Case Report and Review of the Literature

INTRODUCTION

Pelvic schwannomas are rare, mostly benign tumors. They are usually asymptomatic until their massive growth compresses adjacent organs. We describe the case of a 53-year-old man with a pelvic schwannoma who initially complained of constipation and urinary retention.

AREAS COVERED

We analyzed the clinical presentation, histopathology, diagnostic imaging tools, and the treatment options for pelvic schwannomas, compared with the few other cases reported in the literature.

EXPERT COMMENTARY

Pelvic schwannomas are masses that can grow to considerable size, producing symptoms over time. Due to their size and localization, surgery, although difficult, is the only available treatment.

Robotic resection of an obturator schwannoma with preservation of normal nerve fascicles and function

An asymptomatic pelvic tumor was incidentally found in a 27-year-old man. A CT-guided needle biopsy with a pathologic examination confirmed the diagnosis of a benign schwannoma. We describe the complete robotic resection with the conservation of normal fascicles. The postoperative course was uneventful. No neurological deficit occurred, and the electromyogram was normal 6 weeks and 7 months later.

Robot-Assisted Laparoscopic Resection of a Pelvic Schwannoma

There is minimal data within the literature demonstrating the use of robotics to resect pelvic, benign schwannoma(s). Herein, we describe a case of a 46-year-old transgender male that presented with complaints of left-sided pelvic pain. Pre-operatively, the etiology was unknown. The patient underwent robotic-assisted laparoscopic excision of the pelvic mass, including a 5–6 cm resection of the obturator nerve, successfully. Final pathology found a benign schwannoma. Schwannomas are difficult to diagnose pre- and intra-operatively and are thus frequently misdiagnosed as urologic or gynecologic lesions. This report demonstrates that robotics can be used safely to resect benign, pelvic schwannoma(s).

Laparoscopically resected obturator nerve schwannoma: A case report

Obturator nerve schwannomas are very rare. To date, only nine cases have been reported in the English-language literature; none of these were diagnosed preoperatively. A 68-year-old woman was admitted with left lower abdominal pain. CT and MRI revealed a mass 30 mm in diameter in the left obturator fossa, suggesting a retroperitoneal tumor. Because CT and MRI revealed clear continuity with the left obturator nerve, this case was diagnosed as an obturator nerve schwannoma. Tumor enucleation was performed by laparoscopy. On histopathological examination, this case was diagnosed as a benign obturator nerve schwannoma. Postoperatively, the patient developed weakness of the adductor muscle but recovered within 6 months with rehabilitation therapy. Preoperative diagnosis of obturator nerve schwannomas is quite difficult, but careful inspection of CT and MRI is important to identify the original nerve of schwannoma preoperatively. Accordingly, laparoscopic resection is a good treatment option.

Laparoscopic resection of a retroperitoneal schwannoma located in the hepatic hilus

Schwannomas are tumors and commonly occur in the head and neck region; however, they rarely present in the retroperitoneum. A 79-year-old man was admitted to our hospital for a follow-up of a tumor in the hepatic hilus. A 2.8 × 2.5 cm solid tumor located between the hepatic hilus and common hepatic artery was originally identified, and the size of the tumor had increased from 2.0 × 2.0 cm to 2.8 × 2.5 cm over the course of 3 years. The patient underwent percutaneous sonopsy, and the tumor was subsequently diagnosed as a benign schwannoma. Since the patient wished to undergo an operation, we performed laparoscopic surgery. During the operation, the tumor was detected in the retroperitoneal space, where it was strongly adhered between the left gastric artery and common hepatic artery. At this point, no major vessels had vascularized the tumor. We then completely removed the tumor from the retroperitoneal space without any complications. The clinical course was uneventful, and the patient was discharged on postoperative day 4 without any symptoms. Later, a definitive histopathologic examination revealed a benign schwannoma. Here, we report this rare case of a retroperitoneal schwannoma located in the hepatic hilus.

Laparoscopic management of rare retroperitoneal tumors

Due to their close proximity to major vessels, large size, variable location, and unknown malignant status, retroperitoneal tumors are frequently managed by open surgical exploration. Between 2005 and 2008, 4 patients with retroperitoneal tumors were subjected to laparoscopic management and there was success in 3 cases. Conversion to open resection was needed in 1 case because of bleeding. Mean laparoscopic operative time and blood loss were 154 minutes and 116 mL, respectively. The average hospital stay for the patients who were operated laparoscopically was 4 days. One patient had lymph drainage during the postoperative period and was treated conservatively. The histology reported retroperitoneal ganglioneuroma, retroperitoneal schwannoma, and retroperitoneal paraganglioma. There has been no tumor recurrence at a mean follow-up of 39 months. With advanced laparoscopic skills, better instrumentation, and vastly improved imaging, laparoscopic surgery is feasible even for rare retroperitoneal tumors, and in a selected group of patients it can be the first surgical option.