Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2019; 11(3): 191-197
Published online Mar 27, 2019. doi: 10.4240/wjgs.v11.i3.191
Laparoscopic celiac plexus ganglioneuroma resection: A video case report
Pouya Hemmati, Omar Ghanem, Juliane Bingener
Pouya Hemmati, Juliane Bingener, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States
Omar Ghanem, General Surgery, Mosaic Life Care, St. Joseph, MO 64506, United States
Author contributions: All authors were involved in the operation, patient care, and manuscript drafting and critical revision; Bingener J was the primary surgeon; Hemmati P performed the literature review.
Informed consent statement: The patient remains anonymous and provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Pouya Hemmati, MD, Doctor, Surgeon, Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN55905, United States. hemmati.pouya@mayo.edu
Telephone: +1-507-2843975 Fax: +1-507-2845196
Received: February 3, 2019
Peer-review started: February 11, 2019
First decision: February 26, 2019
Revised: March 14, 2019
Accepted: March 20, 2019
Article in press: March 20, 2019
Published online: March 27, 2019
Processing time: 52 Days and 12.1 Hours
Abstract
BACKGROUND

Ganglioneuromas are mature, benign neurogenic tumors that arise from neural crest-derived cells. Given the rarity of these tumors and their often close proximity to major vessels, there is a paucity of reports in the literature of minimally invasive resections of ganglioneuromas near the celiac plexus. We report a case of laparoscopic resection of a retroperitoneal ganglioneuroma adhering to the portal vein and celiac axis.

CASE SUMMARY

A 27-year-old female was referred to our medical center with a symptomatic retroperitoneal mass. Using high quality preoperative imaging and biopsies, we confirmed the diagnosis of a 4 cm ganglioneuroma abutting the celiac axis, portal vein, and the caudate lobe of the liver. We elected for laparoscopic resection after careful preoperative planning and discussions with the patient. Laparoscopy enhanced visualization of the tumor and its relationships to surrounding vital structures for optimal dissection. Ultrasonic energy devices and adjusting liver retraction to allow for manipulation of the mass facilitated a safe and effective resection in a tight space. There were no operative complications and the patient was discharged home on postoperative day 1 with no residual symptoms upon follow-up. With sufficient experience in laparoscopic surgery and preoperative imaging and diagnostics, a minimally invasive approach for removing this celiac plexus ganglioneuroma was successful.

CONCLUSION

In carefully selected patients, laparoscopic ganglioneuroma resection is appropriate, reducing postoperative morbidity, hospital length of stay, and recovery time.

Keywords: Ganglioneuroma; Celiac plexus; Laparoscopic surgery; Case report

Core tip: Ganglioneuromas are rare, benign neurogenic tumors. Given their often close proximity to major vessels, minimally invasive resection can be challenging. We report a case of laparoscopic resection of a retroperitoneal ganglioneuroma adhering to the portal vein and celiac axis. Laparoscopy enhanced visualization of the tumor and its relationships to surrounding vital structures. Ultrasonic energy devices and adjusting liver retraction allowed for manipulation of the mass and safe dissection in a tight space. With sufficient experience in laparoscopic surgery, careful patient selection, and preoperative imaging and diagnostics, laparoscopic ganglioneuroma resection can reduce postoperative morbidity, hospital length of stay, and recovery time for the patient.