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Laparoscopic Extirpation of a Schwannoma in the Lateral Pelvic Space

View Article: PubMed Central - PubMed

ABSTRACT

Schwannomas in the lateral pelvic space are very rare. Here, we report the case of a 48-year-old woman who had a tumor detected in her abdomen by abdominal ultrasonography. Abdominal computed tomography and magnetic resonance imaging revealed a well-defined solid tumor of 65 mm in diameter in the right lateral pelvic space. We performed laparoscopic surgery under a diagnosis of a gastrointestinal tumor or neurogenic tumor. The tumor was safely dissected and freed from the surrounding tissues using sharp and blunt maneuvers. The tumor originated from the right sciatic nerve. Complete laparoscopic extirpation was performed with preservation of the right sciatic nerve. Pathological examination suggested schwannoma. The patient recovered well but had remaining sciatic nerve palsy in her right foot. Laparoscopic extirpation for a schwannoma in the lateral pelvic space was safe and feasible due to the magnified surgical field afforded by laparoscopy.

No MeSH data available.


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This was the surgical view with the preserved right sciatic nerve (arrow) after extirpation of the tumor.
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fig3: This was the surgical view with the preserved right sciatic nerve (arrow) after extirpation of the tumor.

Mentions: We placed the patient in the lithotomy position under general anesthesia and inserted a ureter stent into the right ureter to prevent intraoperative injury. Next, we placed a 12 mm trocar with camera at the umbilicus using the open method. We then placed four 5 mm trocars at the bilateral upper and lower quadrants. The camera showed that the mass lesion (approximately 70 mm in diameter) covered the retroperitoneum in the right lateral pelvic space. We divided the right ureter and exposed the external iliac artery and vein. The tumor was located close to the right internal iliac artery and vein. We carefully isolated the tumor from the surrounding tissue using a THUNDERBEAT handheld system (Olympus Corporation, Japan). We dissected the obturator artery and vein to secure the surgical field. We resected the branches of the internal iliac vein as they were firmly adhered to the tumor. We carefully dissected the tumor from the surrounding tissues using both sharp and blunt maneuvers. The tumor was located at the dorsal side of the right sciatic nerve and was firmly adhered to the nerve (Figure 2). We suspected the mass to be a neurogenic tumor arising from the right sciatic nerve. The tumor was carefully isolated from the right sciatic nerve and freed from the surrounding tissues. We enlarged the umbilical incision to 4 cm and inserted a Smart Retractor (TOP Corporation, Japan). We removed the tumor through the enlarged incision covered by the Smart Retractor. No spillage occurred. After complete extirpation of the tumor, we preserved the right sciatic nerve in the right lateral pelvic space (Figure 3). Finally, we inserted a drain into the pouch of Douglas. The total operative time was 330 min, and total blood loss was 126 mL.


Laparoscopic Extirpation of a Schwannoma in the Lateral Pelvic Space
This was the surgical view with the preserved right sciatic nerve (arrow) after extirpation of the tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120176&req=5

fig3: This was the surgical view with the preserved right sciatic nerve (arrow) after extirpation of the tumor.
Mentions: We placed the patient in the lithotomy position under general anesthesia and inserted a ureter stent into the right ureter to prevent intraoperative injury. Next, we placed a 12 mm trocar with camera at the umbilicus using the open method. We then placed four 5 mm trocars at the bilateral upper and lower quadrants. The camera showed that the mass lesion (approximately 70 mm in diameter) covered the retroperitoneum in the right lateral pelvic space. We divided the right ureter and exposed the external iliac artery and vein. The tumor was located close to the right internal iliac artery and vein. We carefully isolated the tumor from the surrounding tissue using a THUNDERBEAT handheld system (Olympus Corporation, Japan). We dissected the obturator artery and vein to secure the surgical field. We resected the branches of the internal iliac vein as they were firmly adhered to the tumor. We carefully dissected the tumor from the surrounding tissues using both sharp and blunt maneuvers. The tumor was located at the dorsal side of the right sciatic nerve and was firmly adhered to the nerve (Figure 2). We suspected the mass to be a neurogenic tumor arising from the right sciatic nerve. The tumor was carefully isolated from the right sciatic nerve and freed from the surrounding tissues. We enlarged the umbilical incision to 4 cm and inserted a Smart Retractor (TOP Corporation, Japan). We removed the tumor through the enlarged incision covered by the Smart Retractor. No spillage occurred. After complete extirpation of the tumor, we preserved the right sciatic nerve in the right lateral pelvic space (Figure 3). Finally, we inserted a drain into the pouch of Douglas. The total operative time was 330 min, and total blood loss was 126 mL.

View Article: PubMed Central - PubMed

ABSTRACT

Schwannomas in the lateral pelvic space are very rare. Here, we report the case of a 48-year-old woman who had a tumor detected in her abdomen by abdominal ultrasonography. Abdominal computed tomography and magnetic resonance imaging revealed a well-defined solid tumor of 65 mm in diameter in the right lateral pelvic space. We performed laparoscopic surgery under a diagnosis of a gastrointestinal tumor or neurogenic tumor. The tumor was safely dissected and freed from the surrounding tissues using sharp and blunt maneuvers. The tumor originated from the right sciatic nerve. Complete laparoscopic extirpation was performed with preservation of the right sciatic nerve. Pathological examination suggested schwannoma. The patient recovered well but had remaining sciatic nerve palsy in her right foot. Laparoscopic extirpation for a schwannoma in the lateral pelvic space was safe and feasible due to the magnified surgical field afforded by laparoscopy.

No MeSH data available.


Related in: MedlinePlus