Laparoscopic exploration in the management of retroperitoneal masses

The isolated finding of a retroperitoneal mass (RM) often represents a diagnostic challenge. Image-guided biopsy is frequently inadequate for diagnosis. With increasing experience, the use of laparoscopy for exploration of an indeterminate RM may provide a minimally invasive alternative to open exploration. Herein, we present a retrospective review of our initial four laparoscopic explorations, comparing our experience to four contemporary open explorations for an RM.

From July 1995 to January 1998, four patients, aged 50 to 62 years old, with an RM of undetermined etiology underwent laparoscopic exploration. Another four patients underwent open exploration at the same hospital. The medical records of these patients were reviewed.

The tumors were smaller in the laparoscopic group, averaging 3.7 cm (range 2-6 cm) vs 6.5 cm (range 1-10 cm) in the open group. A definitive diagnosis was obtained for all eight patients. Postoperative complications were observed in one of the laparoscopic explorations, and in three of the open explorations; there was no operative mortality. The blood loss (90 vs 440 ml), fall in hematocrit (5.1 vs 7.8%), time to resumption of a regular diet (3 vs 5 days), amount of morphine sulfate equivalents required for analgesia (128 mg vs 161 mg), time to ambulation (2.3 vs 6 days) and hospital stay (4.8 vs 6 days) were all less among the laparoscopy patients. However, the operative time was longer for the laparoscopic procedure; this time included stent placement and patient repositioning in addition to the time for laparoscopic excision of the mass (7.8 vs 4.3 hours).

Laparoscopic exploration appears to be a viable alternative to open exploration in patients presenting with a retroperitoneal mass. It is as effective as an open procedure and provides benefits with regard to patient morbidity and convalescence. However, operative time for this laparoscopic procedure is lengthy.