Laparoscopic excision of a schwannoma arising in the psoas muscle.

Schwannoma occurring in the psoas muscle is rare. We report a 49-year-old male who presented to the orthopaedic oncosurgery team with persistent lower back pain radiating to the right lower limb following a fall on the back a few months ago. Magnetic resonance imaging revealed a well-defined lesion in the right psoas muscle at the level of third lumbar vertebra (L3). He underwent a laparoscopic excision of this mass using one 10 mm and two 5 mm ports. Intraoperative frozen section after a complete excision showed this to be a benign schwannoma. He was discharged the day after surgery. His symptoms gradually reduced over a period of time and he remains well 3 years after surgery. This case highlights the feasibility and safety of minimally invasive treatment of this rare tumour.

Extensive cavo-atrial and hepatic venous tumor thrombus in a mismanaged retroperitoneal pediatric germ cell tumor: A unique surgical challenge.

Retroperitoneal germ cell tumor with tumor thrombosis of the inferior vena cava (IVC) represents a rare phenomenon. Its extension to the hepatic veins (HVs) has not been reported yet. In the present case, a 30-month-old girl had a recurrent retroperitoneal yolk sac tumor with liver metastasis. In addition, there were tumor thrombi in the IVC, right atrium (RA), and all three HVs. The child was operated after a satisfactory response to chemotherapy. Excision of the retroperitoneal tumor with right hepatectomy, retrohepatic caval resection, HV, and RA thrombectomy was performed under a cardiac bypass. HV cloaca was patched with pericardium while the IVC resection was tolerated without reconstruction. Her postoperative recovery was normal. The child currently remains disease-free and symptom-free at 12 months. This case demonstrates the technique of hepatic venous thrombectomy and the feasibility of radical surgery even for a metastatic disease when tumor biology is favorable. Despite wide-spread tumor thrombosis that would have been deemed unresectable, complete resections are possible in referral centers.

Intra-thoracic migration of a gallstone and its thoracoscopic management.

Intra-thoracic migration of a gallstone spilled during laparoscopic cholecystectomy is an extremely rare complication. This is a video documenting the successful thoracoscopic management of a patient who presented with this entity.

Laparoscopic stapled resection/plication of left hemi-diaphragmatic eventration in an adult.

We report a 59-year-old man who presented with progressive dyspnea of 30 years. His pulmonary function tests showed reduced forced expiratory volume in the first second and forced vital capacity and computed tomography of the chest showed eventration of the left hemi-diaphragm. He underwent successful laparoscopic stapled resection / plication of the lax hemi-diaphragm. He was discharged on the fourth postoperative day with the intercostal drain in situ and this was removed 5 days later at follow up. Postoperatively the pulmonary function showed significant improvement and he remains well 2 years after surgery.

Laparoscopic repair of a combined transmesocolic, transomental hernia.

Transmesocolic and transomental hernias (TOHs) are rare types of internal hernia. Both these hernias occurring concurrently in a patient are even rarer. We report a patient with signs of recurrent small-bowel obstruction who was found to have a dual transmesocolic, TOH. Computed tomography imaging and subsequent laparoscopic exploration identified small-bowel loops passing through a defect in the transverse mesocolon behind the stomach to emerge through the gastrohepatic omentum. This was treated successfully by laparoscopy. To the best of our knowledge, this is the first reported case of a combined transmesocolic, TOH undergoing successful laparoscopic repair.