Totally laparoscopic management of retrocaval metastatic melanoma in a young patient: a video vignette

The retroperitoneum can host primary or metastatic lesions and occasionally, a complete surgical resection is the only potential curative treatment.1 The laparoscopic approach has proven feasible and safe for the removal of intra-abdominal lesions2 including large lesions in close proximity to vital structures. Nevertheless, the anatomical location impacts the feasibility of a mininvasive approach for a central retroperitoneal lesion.3,4 This video [online] shows the management of a retrocaval lesion via a totally laparoscopic surgical approach. A 24-year-old female experienced episodes of early satiety and abdominal discomfort. Abdominal ultrasound and magnetic resonance image revealed a solid mass in the right adrenal lodge, extending up to the region between the vena cava and the portal vein. The 55 × 44 mm retrocaval lesion was suspected to be a retroperitoneal tumor, and an explorative laparoscopy was proposed. Despite the close proximity of the lesion to major vessels (vena cava, aorta, and portal vein) and visceral organs (liver and duodenum), the surgeon performed a total laparoscopic wide radical resection. To obtain macroscopically complete clearance, the resection mandated a right adrenalectomy due to vascular supply involvement. Operative time was 95 min without intraoperative complications. The postoperative course was uneventful with rapid recovery lasting 3 days and an optimal cosmetic result. The final diagnosis was defined by histopathological analysis: melanoma metastasis with HMB and MART-1 positivity. This video [online] shows that a laparoscopic approach is safe and feasible but challenging for retroperitoneal lesions, suggesting that a retrocaval location is not an absolute contraindication to this method if performed by an expert laparoscopic surgeon. The patient underwent endoscopic examinations for the lower- and upper-gastrointestinal, accurate dermatological, ophthalmologist, and gynecological examinations. All tests were negative and it was not possible to identify the primary site of the melanoma. Therefore, the oncology group proposed non-evidence of disease as the final diagnosis. Patient started immunotherapy and serial clinical and strumental follow-up. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"This video shows the management of a retrocaval lesion via a totally laparoscopic surgical approach","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_s4sg5zfl"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}