Category: Robotic Surgery: New Techniques - Benign

VS7-13 - Robotic enucleation of retroperitoneal Schwannoma, right

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Schwannoma can occur wherever peripheral nerve Schwann cells are found. However, retroperitoneal schwannoma is extremely rare. Besides, the da Vinci Surgical System® was less used at neurosurgery area. We present a case of retroperitoneal schwannoma treated by robot-assisted surgery.


Methods :

A 63-year-old man with low back pain received laminectomy of L5/S1 +  Posterior Lumbar Interbody Fusion of L5/S1 + cage under Microscope 2 month earlier. A mass in the retroperitoneal space that was incidentally revealed by magnetic resonance imaging. Computed tomography was performed for further information and showed round mass ( size 2.8cm) with heterogeneous contrast enhancement at right Iliopsoas Compartment.


With a diagnosis of retroperitoneum sarcoma or neurogenic tumor, we scheduled robot-assisted retroperitoneal tumor resection. From intraoperative finding, a 3cm well defined whitish tumor, just over lateral border of psoas muscle, encased by nerve fibers (L4 spinal nerve); neurosurgery doctor was consulted and Schwannoma was confirmed. Then, Enucleation of Schwannoma was done with the maximum amount of nerve preservation. 

During operation, we use three trocars for the robotic camera and working arms and one 12mm assistant trocar initially. Another 5mm assistant trocar was also inserted to lift peri-tumor fat tissue for detail nerve preservation.


Results :

 After operation, pathology showed Schwannoma without malignancy. The patient recovered well except mild numbness over right thigh.


Conclusions :

We present the case with incidental finding of retroperitoneal tumor without obvious neurogenic sign. Enucleation is a common operation method for Neurosurgery for maximum amount of nerve preservation. Table consultation may be a better choice to confirm tumor classification. Robot-assisted retroperitoneal Schwannoma enucleation will be benefit for patients to minimize the injury of nerve.

Lungfeng Cheng

Attending Physicians
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
kaohsiung, Kaohsiung, Taiwan (Republic of China)

Name: LUNG-FENG CHENG
Credentials:Urologist at Taiwan
Title: Attending Physician
Affiliation: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital

Jentai Lin

chief physician
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
Kaohsiung, Kaohsiung, Taiwan (Republic of China)

ChiaCheng Yu

chief physician
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
Kaohsiung, Kaohsiung, Taiwan (Republic of China)

Tonglin Wu

chief physician
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
Kaohsiung, Kaohsiung, Taiwan (Republic of China)