Transperitoneal Laparoscopic Adrenalectomy for Schwannoma with Severe Renal Vein Adhesion.
Yuqi Wu, Menjiang Tu, Song Wu et al.
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Case in brief
A 66-year-old man had an asymptomatic renal hilar mass found on surveillance ultrasound. CT showed a 5-cm irregular soft-tissue mass encasing the hilar vessels and two renal arteries arising from the aorta behind the renal vein. Transperitoneal laparoscopic resection removed the mass en bloc with the adrenal gland, without renal hilar clamping; the renal artery was tagged to help protect the vessels. Recovery was uncomplicated, and he was discharged on postoperative day 2. Pathology showed schwannoma with negative margins, and no recurrence was reported at 12-month follow-up.
What made this case unusual
The mass was severely adherent to the renal vein and encased the hilar vessels, yet was resected laparoscopically without hilar clamping, using preoperative vascular mapping and careful sharp enucleation.
Diagnostic / clinical pearl
For a renal hilar mass involving the vessels, preoperative mapping of renal arterial anatomy can inform a nephron-sparing operative approach; pathology is needed to establish the diagnosis, as imaging showed a soft-tissue mass rather than a specific tumor type.
Why it matters
This case illustrates the feasibility of laparoscopic resection for a selected complex renal hilar tumor while preserving the kidney, although the report does not establish broader outcomes.