Robotic Excision of a Para-aortic Paraganglioma: Expanding Surgical Boundaries through Controlled Decision-making

Abstract

Paragangliomas are rare extra‑adrenal neuroendocrine tumors that can be functional, creating significant anesthetic and surgical challenges due to hypervascularity and proximity to major vessels. We report an elderly woman (>65 years) with a functional left para‑aortic paraganglioma who underwent robotic excision after multidisciplinary optimization. Imaging demonstrated a 6–7 cm lesion nestled between the aorta and inferior vena cava. The operation was performed via a left‑sided transperitoneal approach with deliberate bipolar‑dominant dissection and careful control of feeding vessels. Histopathology confirmed a well-circumscribed paraganglioma showing classic Zellballen architecture with low mitotic activity and negative resection margins. Postoperative recovery was uneventful; the patient was discharged on postoperative day 3 with normalization of catecholamine levels and no recurrence at 3‑month follow‑up. This case highlights how thoughtful case selection, endocrine preparation, and meticulous robotic technique can safely extend minimally invasive surgery to challenging retroperitoneal vascular tumors. These insights can inform training and multidisciplinary pathways and may reduce morbidity for similar patients in the future. It documents endocrine and anesthetic optimization for functional disease, which is critical for reproducibility and safety. By detailing access strategy, port placement, and bipolar‑dominant dissection in the para‑aortic space, this report offers practical operative guidance. Robotic excision of para‑aortic paraganglioma provides evidence that complex, high‑risk retroperitoneal vascular tumors can be managed safely with minimally invasive surgery in carefully selected patients.