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AUA2020 V10-03: Functioning left renal hilar Extra-adrenal Paraganglioma
AUA2020 V10-03: Functioning left renal hilar Extra-adrenal Paraganglioma: Renal sparing excision with reconstruction of renal vessels
For more 2020 Surgical Videos, visit: https://auau.auanet.org/node/28146
Sachin Nataraj*, Rohan Patel, Feroz Amir, Pankaj wadhwa, Rajesh Ahlawat, Delhi-NCR, India
INTRODUCTION
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. The occurrence of these tumors between the renal artery and the renal vein is very rare. Here we report the case of a 42-year-old woman who presented with paroxysmal hypertension and was found to have a renal hilar paraganglioma. Surgical excision of such tumors involves risk of injuring major vessels and usually ends with partial or total nephrectomy. Herein we present a case of robotic assisted kidney sparing excision of tumor with reconstruction of renal vessels.
METHODS
A 42-year-old women presented with paroxysmal hypertension, on evaluation she was found to have raised 24 hours urine metanephrines and serum Chromogranin (Metanephrine 128.56 mcg, Normetanephrines 1556.12 mcg and Chromogranin A 494.96 mcg). Her Contrast enhanced CT of abdomen showed 8x5x5 cms heterogeneously enhancing mass in left para-aortic and left renal hilar region splaying the renal vessels. After adequate preparation, she underwent robotic assisted excision of tumor with reconstruction of renal vessels
RESULTS
Total operative time was 240 minutes, console time was 175 minutes and Warm ischemia time was 35 minutes. She had a normal post-operative Doppler of left kidney and serum creatinine. Patient was normotensive after day 1. Her CT scans after one moth was normal. DTPA renogram performed at 4 months showed normal function and drainage of left kidney.
CONCLUSIONS
Utilising the advantage of robotic platform a complex tumor like renal hilar paraganglioma can be managed successfully with minimal morbidity and complications. Robotic platform allows added benefit in reconstructing the vascular structures.
SOURCE OF FUNDING: None
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