Abstract
Introduction:
Abdominal paragangliomas are catecolamine-secreting tumors that arise from chromaffin cells located in sympathetic ganglia. They usually occur sporadically but can also have a genetic component. Furthermore, they have a greater potential for malignancy than pheochromocytomas. For this reason and because of its complex anatomical location, open surgery has traditionally been the gold standard treatment.
Materials and Methods:
We present in this video a 30-year-old woman who was diagnosed with a para-aortic nodule by ultrasound while being studied for high blood pressure and diarrhea. A CT scan confirmed the presence of a 5 cm para-aortic nodule over the origin of the inferior mesenteric artery (IMA). Scintigraphy also showed the presence of para-aortic chromaffin tissue. Urine normetanephrines were found to be elevated, leading to the diagnosis of paraganglioma. The patient went through alpha/beta blockade, and laparoscopic excision of the mass was scheduled.
Results:
Initially, an attempt was made to access the retroperitoneum by mobilizing the left colon and sigmoid medially. However, the presence of a rectal artery became evident in a position that did not allow dissection to continue without sectioning it, so it was decided to approach the paraganglioma through the mesocolon. The paraganglioma was found to be lateral to the origin of the IMA and cranial to the left colic artery. Manipulation of the tumor was avoided during the whole procedure. The pathology exam described a 5 cm paraganglioma with a free resection margin.
Conclusions:
Laparoscopic surgery for selected cases of paraganglioma is feasible and safe with adequate preoperative planning.
The authors have nothing to disclose.
Source of work or study. Conflicts of interest.
This video has been recorded at Hospital General Universitario Gregorio Marañón.
The authors have no conflict of interest.
Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.
All contributing authors: Zarain Obrador L, Mercader Cindoncha E, Amunategui Prats I, Fernández Fernández E, Sánchez M, Escat Cortés J.L.
Runtime of video: 12 min 21 sec.