Laparoscopic ultrasound assisted laparoscopic retroperitoneal schwannoma excision.

Schwannomas are rare, benign tumors that originate from the neural sheath. Rarely, schwannomas can arise from the retroperitoneum and adrenal medulla. We describe a case of a 61-y-old man who presented with an incidentally discovered retroperitoneal tumor near right adrenal gland.

A 61 year old male patient presented with a severe right flank pain. He had no hematuria, dysuria or any urological symptoms. Magnetic resonance images and computed tomography scans revealed a 25 mm lesion with solid and cystic areas near the adrenal gland. Metanephrin and normethanephrine levels were increased in 24-hour urine test. The differential diagnosis was pheochromacytoma or paraganglioma. Intraoperative laparoscopic ultrasound assisted laparoscopic resection of retroperitoneal tumor excision was performed to the patient. Right surrenal was spared by using intraoperative laparoscopic ultrasound. The total operative time was 55 minutes and the estimated blood loss was 50 ml. Postoperative period was uneventful, the drainage catheter was removed on the postoperative 1st day and the patient was discharged on the postoperative 2nd day. Pathological examination revealed a retroperitoneal schwannoma. The patient's first year controls were completely normal. The assistance of laparoscopic ultrasound was helpful for adrenal sparing surgery in our case by defining tumor margins.

Peroperative laparoscopic ultrasound use could help urologists in providing safety margins especially with endophytic renal mass and operations can be completed with less amount of parenchymal loss. This imaging modality was used in evaluation of pancreatic cancer staging and resectability, identification of endophitic renal tumors.

In conclusion, laparoscopic ultrasound is a safety and useful method for organ-sparing laparoscopic surgery.