Robot-assisted resection of retrocaval paraganglioma: technical considerations and approach.
Kayleigh M Herrick-Reynolds, Sebastiaan Ceuppens, Linwah Yip et al.
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Case in brief
A 27-year-old man with von Hippel–Lindau syndrome was found to have a recurrent paraganglioma in the retrocaval space, following right partial adrenalectomy at age 16. The 3.8-cm tumour lay posterior to the left renal vein and abutted the right renal hilum. He underwent robot-assisted resection, with preoperative planning and operative techniques used to manage the confined dissection and minor bleeding while preserving a minimally invasive approach. The tumour was completely resected; his hospital course was uncomplicated, and he was discharged on postoperative day one.
What made this case unusual
The recurrent tumour occupied a challenging retrocaval/aortocaval position, posterior to the left renal vein and adjacent to the right renal hilum. The report highlights technical strategies for visualization, retraction, and control of minor bleeding in this confined space.
Diagnostic / clinical pearl
In a patient with von Hippel–Lindau syndrome and prior adrenal surgery, consider recurrent paraganglioma when a retrocaval mass is identified; careful preoperative planning is central to the reported minimally invasive approach.
Why it matters
The authors note that patients with von Hippel–Lindau syndrome face a high risk of recurrence and may require further operations, making approaches that can achieve resection while maintaining minimally invasive surgery relevant to their care.