Transperitoneal Laparoscopic Adrenalectomy for Schwannoma with Severe Renal Vein Adhesion

Renal hilum neurogenic tumors predominantly comprising schwannomas, ganglioneuromas, and paragangliomas, present formidable surgical challenges owing to their intimate association with the renal pedicle vasculature.¹ Critical difficulties arise from tumor encasement of renal arteries/veins and the anatomical constraints of the hilum "sandwich" (tumor-vessel interface spacing often < 1 cm), necessitating precision techniques for complete oncologic resection while preserving renal function.^2,3 Minimally invasive approaches for these complex lesions remain underexplored despite their potential for nephron sparing.

This video presents a 66-year-old male with asymptomatic renal hilar mass detected incidentally during routine surveillance ultrasound. Preoperative computed tomography (CT) demonstrated a 5-cm soft tissue mass with irregular borders, encasing the hilar vessels, and revealed two renal arteries originating from the aorta posterior to the renal vein. The surgical technique emphasized critical refinements: preoperative vascular mapping, sharp tumor enucleation without renal hilar clamping, and silk-loop tagging of the renal artery to preserve vascular integrity.

En bloc resection of the tumor with the adrenal gland was completed, ensuring intact surgical margins. Operative time was 115 min, and estimated blood loss was 120 ml. The patient's recovery was uneventful without complications, and he was discharged on postoperative day 2. Final pathology confirmed schwannoma, with negative margins and no recurrence at 12-month follow-up.

Transperitoneal laparoscopic resection represents a feasible and nephron-sparing alternative to radical surgery for selecting renal hilar tumors, particularly in cases of solitary kidney or high surgical risk. Success depends on careful preoperative planning, meticulous sharp enucleation, and advanced vascular control techniques.