Precision en-bloc retroperitoneal paraganglioma resection performed laparoscopically: A case report

Phaeochromocytoma and paragangliomas (PPGL) are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves, with an overall incidence of approximately 0.66 cases per 100000 people per year. Most PPGLs are asymptomatic, and a few develop symptoms, such as elevated blood pressure and rapid heart rate, because of the release of catecholamines. According to the literature, surgical resection is the mainstay of PPGL treatment. However, the choice between minimally invasive surgery and open surgery remains controversial, particularly in cases involving complex anatomical relationships. We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography (CT) angiography and three-dimensional reconstruction, resulting in a favorable outcome.

A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months, experiencing occasional pins and needles sensation and radiation from the right shoulder and back. Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma. Surgery was recommended, and an enhanced CT scan of the upper abdomen, along with preoperative three-dimensional reconstruction, was performed after admission. The imaging indicated that the mass, measuring approximately 4.1 cm × 3.8 cm × 4.8 cm, was situated between the abdominal aorta and the inferior vena cava, extending downward to the level of the left renal vein. After ruling out any contraindications to surgery, a minimally invasive laparoscopy was performed to excise the mass precisely. The surgery was successful without any postoperative complications, and the 2-month follow-up revealed no abnormal signs of recurrence.

This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor. The patient recovered well during the 2-month follow-up, and postoperative pathology revealed a paraganglioma.