Retroperitoneal schwannomas are rare, accounting for just 0.5–3.0% of all schwannomas and only 1% of all peritoneal neoplasias . As these tumors are usually asymptomatic and discovered by chance or in the course of the evaluation of an unrelated health problem, they may cause a delay in their early diagnosis and treatment. The ideal treatment for schwannoma is complete resection of the tumor and capsule without injuring the adherent organs .
With recent advances in the field of minimally invasive surgery, several laparoscopic approaches to retroperitoneal schwannomas have been reported [13, 14]. Laparoscopic surgery, which has become a useful and feasible option for this procedure, is associated with minimal invasiveness and early postoperative recovery. The medial-retroperitoneal approach is the surgical technique for laparoscopic right colectomy . The anatomical landmarks of the medial-retroperitoneal approach are the third portion of the duodenum, the mesenteric root of the terminal ileum, and the caudal portion of the cecum. This approach begins with an incision of the peritoneum at the base of the mesentery of the intestine. After lifting the cecum or the terminal ileum ventrally, the dissection is performed just dorsal to the right fusion fascia of Toldt and sufficiently to the cranial side and then continues medially to the second portion of the duodenum (Fig. 7a). We decided to perform this approach based on simulating the surgery using the 3D images obtained preoperatively. The medial-retroperitoneal approach is the preferred procedure in laparoscopic resection of retroperitoneal tumors because it involves wide dissection of the ventral side of the deep subperitoneal fascia and the surface of the duodenum and thus provides a favorable surgical field (Fig. 7b).
A retroperitoneal tumor can be in close contact with structures such as the duodenum, right renal vein, and IVC, which often require meticulous dissection to avoid damage. Thus, precise knowledge of the surgical anatomy of each patient is absolutely mandatory to ensure a safe operation. Since the SYNAPSE VINCENT can create 3D images based on preoperative CT images, so there is no burden on the patients and making it easier for the surgeon to visually recognize the anatomy and have a common understanding. In the fields of hepatic [3, 4] and thoracic surgery [5, 6] in particular, preoperative simulation has been widely used, and the safety and efficacy of 3D images for preoperative assessment have already been described [7,8,9,10]. The use of 3D images for retroperitoneal tumor resection, as in our case, is a very effective and new technique with few prior studies.
Preoperative simulation and intraoperative navigation with 3D images are useful methods to enhance the surgeon’s understanding of a patient’s specific anatomy and are especially effective when resecting a retroperitoneal tumor in an anatomically deep and complex location. Three-dimensional images can be rotated freely and visualized interactively from any angle to provide an overview of the 3D relationships of the retroperitoneal organs. In addition, information about the location of the tumor can be shared between each operator and doctors from other departments, ensuring secure resection in a narrow retroperitoneal space near important densely packed organs. This imaging technique not only is helpful for laparoscopic retroperitoneal procedures but is an excellent tool for the education of surgical trainees and for medical students studying surgical anatomy.
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