Laparoscopic Minimally Invasive Approach for Left Paracaval Retroperitoneal Schwannoma

Schwannomas are rare mesenchymal tumors and represent the most frequent benign nerve tumor in the retroperitoneum.^1,2 Their close relationship with major vascular structures can make surgical management technically demanding. Laparoscopic resection in the aortocaval region is rarely reported^3-6 and requires meticulous dissection to preserve adjacent vessels.^7,8 METHODS: We report the case of a 55-year-old man with an incidentally detected retroperitoneal mass. Computed tomography showed a 4 cm lesion posterior to the pancreas, closely related to the inferior vena cava and left renal vein. Endoscopic ultrasound-guided biopsy suggested schwannoma. The decision for upfront laparoscopic surgery was made after multidisciplinary discussion, considering both the anatomical location of the lesion and patient preference.

A five-port laparoscopic approach was used. Following right colic mobilization and extended Kocher maneuver, the lesion was exposed. Dissection along an avascular plane allowed safe separation from the inferior vena cava and left renal vein, preserving the superior mesenteric artery. Operative time was 200 minutes with 200 mL blood loss and no intraoperative complications. Recovery was uneventful, and the patient was discharged on postoperative day 5. Pathology confirmed a 4.5 cm schwannoma with negative margins. At 1-year follow-up, the patient is disease free.

Laparoscopic resection of retroperitoneal schwannomas abutting major vascular structures is feasible and safe in carefully selected patients when performed in specialized centers.^9-11 The role of preoperative biopsy is paramount. Histology plays a pivotal role in surgical planning, as the extent of resection must be tailored according to oncologic principles.