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Laparoscopic phrenectomy for a diaphragmatic neurilemmoma.

Liu K, Zhang M, Liang X, Cai X - J Res Med Sci (2013)

Bottom Line: Even when diagnosed, patients are commonly advised only to attend regular follow-up appointments as conventional tumorectomy is enormously invasive and confers relatively few benefits.The entire operation lasted 65 min, and patient was discharged uneventfully on the 3(rd) post-operative day.The follow-up for 29 months has shown with no recurrence or symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatobiliary Surgery, Ocean University of China, Qingdao 266071, China.

ABSTRACT
Diaphragmatic neurilemmoma (schwannoma) is an extremely rare tumor that is often discovered incidentally. Even when diagnosed, patients are commonly advised only to attend regular follow-up appointments as conventional tumorectomy is enormously invasive and confers relatively few benefits. Here, we report a unique case of a diaphragmatic neurilemmoma with concomitant symptomatic cholecystolithiasis, who was treated successfully by pure laparoscopy. The entire operation lasted 65 min, and patient was discharged uneventfully on the 3(rd) post-operative day. The follow-up for 29 months has shown with no recurrence or symptoms.

No MeSH data available.


Related in: MedlinePlus

(a) The tumor had been resected, a continuous suture of the diaphragm was done by laparoscopic approach, (b) two absorbable lapro-clips (Covidien Inc.) were applied to reinforce the suture (black arrowhead). The leak tightness was examined while the anesthetist expanded the lungs (white arrowhead: Laparoscopic Peng's Multifunctional Operative Dissector; red arrowhead: Falciform ligament), (c) the specimen was packed into a plastic bag, (d) macroscopic examination through a cut section, (e) microscopic examination (H and E, stain) of the tumor
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Figure 2: (a) The tumor had been resected, a continuous suture of the diaphragm was done by laparoscopic approach, (b) two absorbable lapro-clips (Covidien Inc.) were applied to reinforce the suture (black arrowhead). The leak tightness was examined while the anesthetist expanded the lungs (white arrowhead: Laparoscopic Peng's Multifunctional Operative Dissector; red arrowhead: Falciform ligament), (c) the specimen was packed into a plastic bag, (d) macroscopic examination through a cut section, (e) microscopic examination (H and E, stain) of the tumor

Mentions: Patient was placed in the prone position and four trocars were employed in accordance with our previous report:[6] An umbilical trocar of 10 mm for the camera, a sub-xiphoid trocar of 12 mm as the main port, and two 5 mm trocars at the right midclavicular line for the assistant. A thorough exploration was undertaken, and a 3 cm mass underneath the right diaphragm was identified. At that time, an anti-Trendelenburg position was introduced, and the anesthesiologists turned down the tidal volume accordingly. While, the assistant fixed the diaphragm 2 cm away from the tumor, the surgeon performed a partial phrenectomy with our Laparoscopic Peng's Multifunctional Operative Dissector.[6] Afterward, the diaphragm was continuously sutured with 2-0 Vicryl sutures [Ethicon Inc.; Figure 2a]. The anesthesiologists were asked to manually expand the lungs using a breathing bag before the last suture was knotted in order to extrude the carbon dioxide from the thoracic cavity. Subsequently, the right subphrenic space was infused with water to perform an air test in the Trendelenburg position to identify any remaining diaphragmatic defects [Figure 2b]; in addition, water was used to rule out an ongoing hemorrhage. Finally, a normal tidal volume and the anti-Trendelenburg position were resumed, and laparoscopic cholecystectomy was performed. The specimens were packed in a plastic bag and extracted via the 12 mm port [Figure 2c]. A gross section of the mass revealed a multilobulated, yellowish, solid tumor with cystic parts [Figure 2d], and the intraoperative frozen section pathological diagnosis was a diaphragmatic neurilemmoma.


Laparoscopic phrenectomy for a diaphragmatic neurilemmoma.

Liu K, Zhang M, Liang X, Cai X - J Res Med Sci (2013)

(a) The tumor had been resected, a continuous suture of the diaphragm was done by laparoscopic approach, (b) two absorbable lapro-clips (Covidien Inc.) were applied to reinforce the suture (black arrowhead). The leak tightness was examined while the anesthetist expanded the lungs (white arrowhead: Laparoscopic Peng's Multifunctional Operative Dissector; red arrowhead: Falciform ligament), (c) the specimen was packed into a plastic bag, (d) macroscopic examination through a cut section, (e) microscopic examination (H and E, stain) of the tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3818626&req=5

Figure 2: (a) The tumor had been resected, a continuous suture of the diaphragm was done by laparoscopic approach, (b) two absorbable lapro-clips (Covidien Inc.) were applied to reinforce the suture (black arrowhead). The leak tightness was examined while the anesthetist expanded the lungs (white arrowhead: Laparoscopic Peng's Multifunctional Operative Dissector; red arrowhead: Falciform ligament), (c) the specimen was packed into a plastic bag, (d) macroscopic examination through a cut section, (e) microscopic examination (H and E, stain) of the tumor
Mentions: Patient was placed in the prone position and four trocars were employed in accordance with our previous report:[6] An umbilical trocar of 10 mm for the camera, a sub-xiphoid trocar of 12 mm as the main port, and two 5 mm trocars at the right midclavicular line for the assistant. A thorough exploration was undertaken, and a 3 cm mass underneath the right diaphragm was identified. At that time, an anti-Trendelenburg position was introduced, and the anesthesiologists turned down the tidal volume accordingly. While, the assistant fixed the diaphragm 2 cm away from the tumor, the surgeon performed a partial phrenectomy with our Laparoscopic Peng's Multifunctional Operative Dissector.[6] Afterward, the diaphragm was continuously sutured with 2-0 Vicryl sutures [Ethicon Inc.; Figure 2a]. The anesthesiologists were asked to manually expand the lungs using a breathing bag before the last suture was knotted in order to extrude the carbon dioxide from the thoracic cavity. Subsequently, the right subphrenic space was infused with water to perform an air test in the Trendelenburg position to identify any remaining diaphragmatic defects [Figure 2b]; in addition, water was used to rule out an ongoing hemorrhage. Finally, a normal tidal volume and the anti-Trendelenburg position were resumed, and laparoscopic cholecystectomy was performed. The specimens were packed in a plastic bag and extracted via the 12 mm port [Figure 2c]. A gross section of the mass revealed a multilobulated, yellowish, solid tumor with cystic parts [Figure 2d], and the intraoperative frozen section pathological diagnosis was a diaphragmatic neurilemmoma.

Bottom Line: Even when diagnosed, patients are commonly advised only to attend regular follow-up appointments as conventional tumorectomy is enormously invasive and confers relatively few benefits.The entire operation lasted 65 min, and patient was discharged uneventfully on the 3(rd) post-operative day.The follow-up for 29 months has shown with no recurrence or symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatobiliary Surgery, Ocean University of China, Qingdao 266071, China.

ABSTRACT
Diaphragmatic neurilemmoma (schwannoma) is an extremely rare tumor that is often discovered incidentally. Even when diagnosed, patients are commonly advised only to attend regular follow-up appointments as conventional tumorectomy is enormously invasive and confers relatively few benefits. Here, we report a unique case of a diaphragmatic neurilemmoma with concomitant symptomatic cholecystolithiasis, who was treated successfully by pure laparoscopy. The entire operation lasted 65 min, and patient was discharged uneventfully on the 3(rd) post-operative day. The follow-up for 29 months has shown with no recurrence or symptoms.

No MeSH data available.


Related in: MedlinePlus