Laparoscopic resection of schwannoma in the lateral pelvic space based on the fascia plane: how we do it (with video)

Background Research on laparoscopic schwannoma resection (LSR) in the lateral pelvic space (LPS) remains limited. This study aimed to compare the short-term and oncological outcomes of LSR and conventional open schwannoma resection (OSR). Methods Clinical data of 38 patients with lateral pelvic schwannomas were retrospectively collected. LSR in the LPS was based on fascial-oriented techniques. Operation-related results, neurological function, and oncological outcomes were compared. Results A total of 38 patients were enrolled, including 18 and 20 patients who underwent LSR and OSR, respectively. The baseline characteristics showed no significant differences between the groups. The median blood loss and incision length in the LSR group were significantly lower (40.0 vs. 300 mL, 4.5 vs. 15 cm, P < 0.001). The LSR group showed less time to the first flatus (2.0 vs. 3.0 days, P = 0.029), time to pull drainage (5.0 vs. 6.0 days, P = 0.042), time to pull catheter (3.0 vs. 4.0 days, P = 0.027), and postoperative hospital stay (6.0 vs. 8.0 days, P = 0.048). The LSR group also showed fewer postoperative complications than the OSR group, although the difference was not significant (40.0% vs. 16.7%, P = 0.113). At a median follow-up of 36 months, no local recurrence was observed. Conclusions Fascial-oriented laparoscopic resection of schwannomas in the LPS is feasible without compromising oncological safety. LSR shows clear advantages, most notably small incisions, less blood loss, and quick recovery, as well as potential benefits of neurological function.