Hye Kyung Chang, JungHye Kyung Chang, JungHye Kyung Chang, JungHye Kyung Chang, Jung----Tak Oh, Seung Hoon Choi, Seok Joo HanTak Oh, Seung Hoon Choi, Seok Joo HanTak Oh, Seung Hoon Choi, Seok Joo HanTak Oh, Seung Hoon Choi, Seok Joo Han

Division of Pediatric Surgery, Department of Surgery,Division of Pediatric Surgery, Department of Surgery,Division of Pediatric Surgery, Department of Surgery,Division of Pediatric Surgery, Department of Surgery,Yonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineYonsei University College of Medicine

Retroperitoneoscopic Resection of Retroperitoneoscopic Resection of Retroperitoneoscopic Resection of Retroperitoneoscopic Resection of Retroperitoneal MassRetroperitoneal MassRetroperitoneal MassRetroperitoneal Mass

BackgroundBackgroundBackgroundBackground

PurposePurposePurposePurpose

Retroperitoneoscopic SurgeryRetroperitoneoscopic SurgeryRetroperitoneoscopic SurgeryRetroperitoneoscopic Surgeryminimal invasive surgery for retroperitoneal organs

developed during last decade

Retroperitoneoscopy vs. LaparoscopyRetroperitoneoscopy vs. LaparoscopyRetroperitoneoscopy vs. LaparoscopyRetroperitoneoscopy vs. Laparoscopy

preferred tool for the cases of retroperitoneal pathology

advantage of direct route without passage through the abdominal cavityvs. transperitoneal route of wider and more familiar peritoneal chamber

report of a case of a retroperitoneoscopically removed retroperitoneal mass in 7-year-old girl who has V-P shung d/t

hydrocephalus

7-year-old girl(19kg : 3 percentile, 123 cm : 25-50 percentile)

an incidentally found retroperitoneal mass

Historychoroid plexus papilloma with hydrocephalusreceived a few times of operation for V-P shunts

due to uncontrolled hydrocephalusand malfunction of V-P shunt catheter 7 years ago

Case PresentationCase PresentationCase PresentationCase Presentation

Preop. Abd. CTPreop. Abd. CTPreop. Abd. CTPreop. Abd. CT

Preop. Brain CTPreop. Brain CTPreop. Brain CTPreop. Brain CT

well defined mass of6 x 5 cm in size inright retroperitonealspace

Preop. PETPreop. PETPreop. PETPreop. PET

• wellwellwellwell----defineddefineddefineddefined hypoechoichypoechoichypoechoichypoechoic massmassmassmass• compression of Rt.compression of Rt.compression of Rt.compression of Rt. kidneykidneykidneykidney and and and and vessel by the massvessel by the massvessel by the massvessel by the mass• multiplemultiplemultiplemultiple brightbrightbrightbright echo inside the echo inside the echo inside the echo inside the mass : r/omass : r/omass : r/omass : r/o calcificationcalcificationcalcificationcalcification

IMP:IMP:IMP:IMP: R/OR/OR/OR/O neurogenic tumor, neurogenic tumor, neurogenic tumor, neurogenic tumor, retroperitoneumretroperitoneumretroperitoneumretroperitoneum

Preop. Abd. U/SPreop. Abd. U/SPreop. Abd. U/SPreop. Abd. U/S

retroperitoneal approach vs. transperitoneal approachretroperitoneal approach vs. transperitoneal approachretroperitoneal approach vs. transperitoneal approachretroperitoneal approach vs. transperitoneal approach

1) possible intraperitoneal adhesiondue to previous V-P shunt operations

2) benign character of the retroperitoneal lesion on imaging studiessuch as ultrasonogram, CT scan, and PET scan

3) disturbance of V-P shunt function with transperitoneal approach

4) no need for restriction of postop. oral intake with retroperitoneal approach

Retroperitoneoscopic resectionRetroperitoneoscopic resectionRetroperitoneoscopic resectionRetroperitoneoscopic resection

Lt. lateral position with flexion of Lt. flank

post. wound extension for mass removalno drainage inserted

total operating time : 420 minutes

ovoid solid pinkish yellow mass, measuring 5x3.5x4cmpathologic diagnosis was ganglioneuromaganglioneuromaganglioneuromaganglioneuroma

Post. Ant.

four 5mm trocas on Rt. flankfor operator, camera & assistant

Abd. CT f/u on POD #5Abd. CT f/u on POD #5Abd. CT f/u on POD #5Abd. CT f/u on POD #5

ConclusionConclusionConclusionConclusion

I.I.I.I. Retroperitoneoscopic resection of retroperitoneal Retroperitoneoscopic resection of retroperitoneal Retroperitoneoscopic resection of retroperitoneal Retroperitoneoscopic resection of retroperitoneal mass is an acceptable procedure in pediatrics.mass is an acceptable procedure in pediatrics.mass is an acceptable procedure in pediatrics.mass is an acceptable procedure in pediatrics.

II.II.II.II. Retroperitoneal approach for the retroperitoneal Retroperitoneal approach for the retroperitoneal Retroperitoneal approach for the retroperitoneal Retroperitoneal approach for the retroperitoneal lesions is more feasible with its direct route than lesions is more feasible with its direct route than lesions is more feasible with its direct route than lesions is more feasible with its direct route than transperitoneal approach, especially for previous transperitoneal approach, especially for previous transperitoneal approach, especially for previous transperitoneal approach, especially for previous intraabdominal surgery.intraabdominal surgery.intraabdominal surgery.intraabdominal surgery.

III.III.III.III. Resection of benign retroperitoneal pathologyResection of benign retroperitoneal pathologyResection of benign retroperitoneal pathologyResection of benign retroperitoneal pathologymay be performed easily in good result with full may be performed easily in good result with full may be performed easily in good result with full may be performed easily in good result with full

awareness of retroperitoneal anatomy.awareness of retroperitoneal anatomy.awareness of retroperitoneal anatomy.awareness of retroperitoneal anatomy.