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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 lesions (2) including large lesions in close proximity to vital structures. However, the anatomical location impacts the feasibility of a minimally invasive approach for a central retroperitoneal lesion (3, 4). This video shows the management of a retrocaval lesion via a totally laparoscopic surgical approach. A 24-year-old female patient experienced episodes of early satiety and abdominal discomfort. Abdominal ultrasound and MRI revealed a solid mass in the right adrenal lodge, extending up to the region between the vena cava and the portal vein. The 55 by 44mm 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 (i.e., vena cava, aorta, 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 minutes without intraoperative complications. Postoperative outcomes were uneventful. The patient rapidly recovered on postoperative day 3, with optimal cosmetic results. The final diagnosis was established through the histopathological analysis and evidenced metastatic melanoma with HMB and MART-1 positivity. This video showed that the laparoscopic approach was 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 GI, as well as dermatological, ophthalmological, and gynecological examination. All tests proved negative and it was not possible to identify the primary site of the melanoma. Therefore, the oncology group proposed NED (non-evidence of disease) as the final diagnosis. The patient started immunotherapy and was followed up clinically.

Bibliography:
1. Mota, M. M. D. S., Bezerra, R. O. F., & Garcia, M. R. T. (2018). Practical approach to primary retroperitoneal masses in adults. Radiologia brasileira, 51(6), 391–400. https://doi.org/10.1590/0100-3984.2017.0179.

2. Bracale, U., Pacelli, F., Milone, M., Bracale, U. M., Sodo, M., Merola, G., Troiani, T., & Di Salvo, E. (2017). Laparoscopic treatment of abdominal unicentric castleman's disease: a case report and literature review. BMC surgery, 17(1), 38. https://doi.org/10.1186/s12893-017-0238-6.

3. Strauss, D. C., Hayes, A. J., Thway, K., Moskovic, E. C., Fisher, C., & Thomas, J. M. (2010). Surgical management of primary retroperitoneal sarcoma. The British journal of surgery, 97(5), 698–706. https://doi.org/10.1002/bjs.6994.

4. Strauss, D. C., Hayes, A. J., & Thomas, J. M. (2011). Retroperitoneal tumours: review of management. Annals of the Royal College of Surgeons of England, 93(4), 275–280. https://doi.org/10.1308/003588411X571944.

In this key lecture, Dr. Joideep Phadnis, MD outlines the indications of elbow arthroscopy and its clinical applications.

In this key lecture, Dr. Pieter Caekebeke, MD, PhD focuses on clinical elbow examination.

This is the case of a 60-year-old man who underwent a bipolar transurethral resection of the prostate (TURP) two years earlier. The patient developed a bladder neck sclerosis with a serious urinary obstruction and failure which was treated with two endoscopic procedures. Cystoscopy revealed a normal urethra right up to the bladder union. It was decided to perform an anterior reconstruction using a buccal mucosa graft in a transvesical laparoscopic technique.

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.
Join us for a discussion with Professor Arnaud Wattiez, a world-leading gynecologic surgeon renowned for his dedication to excellence and mentorship. Professor Wattiez has not only advanced his field but also fostered a community of top surgeons through his teaching. We will also delve into his transformative journey from France to Dubai, exploring how this move profoundly impacted his personal and professional life, bringing him a newfound balance and contentment. Tune in for an inspiring tale of achievement and personal growth.

In this key lecture, Dr. Rafael F. Coelho, MD, PhD outlines inferior vena cava (IVC) thrombus management during minimally invasive radical nephrectomy.

The authors demonstrate a laparoscopic ureterolysis with omental wrap for treatment of idiopathic retroperitoneal fibrosis refractory to conservative treatment with double-J placement and corticosteroid therapy for 12 months.

Bibliography:
1. Stein RJ, Patel NS, Quinn K, Berger M, Koff W, Shah G, Aron M, Berger AK. Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis. BJU Int. 2010 Sep;106(5):703-7. doi: 10.1111/j.1464-410X.2009.09186.x. PMID: 20128779.
2. Simone G, Leonardo C, Papalia R, Guaglianone S, Gallucci M. Laparoscopic ureterolysis and omental wrapping. Urology. 2008 Oct;72(4):853-8. doi: 10.1016/j.urology.2008.06.011. Epub 2008 Jul 31. PMID: 18674801.
3. Fong BC, Porter JR. Laparoscopic ureterolysis: technical alternatives. J Endourol. 2006 Oct;20(10):820-2. doi: 10.1089/end.2006.20.820. PMID: 17094761.
4. Cristian S, Cristian M, Cristian P, Constantin G, Savu C, Huri E, Sinescu I. Management of idiopathic retroperitoneal fibrosis from the urologist's perspective. Ther Adv Urol. 2015 Apr;7(2):85-99. doi: 10.1177/1756287214565637. Erratum in: Ther Adv Urol. 2016 Apr;8(2):161-2. PMID: 25829952; PMCID: PMC4372523.