PMC3012842_01
Enlarged mass 6 month after the initial MRI scan. Preoperative sagittal (A) and axial (B) T1 enhanced Magnetic Resonance Imaging sans showing a round encapsulated left paravertebral mass at the L4-5 level and CT angiography (C) demonstrating the location close to the aortic bifurcation (Arrow indicates tumor mass).
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F1
During follow-up, MRI scan showed the mass had double in size and was located on the left side of the L4 vertebral body, close to the aortic bifurcation; the patient additionally complained of numbness on his left posterior thigh (Fig. 1).
Diagram shows port placement for robot-assisted paraspinal tumor resection.
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F2
The distances between the trocars were decided enough for avoiding collisions of instruments (Fig. 2).
Operative findings of robot-assisted paraspinal tumor resection. (A) Dissection of tumor through robotic bipolar forceps and monopolar scissors (U, ureter; DL, left arm of da Vinci; DR, right arm of da Vinci; F, paracolic fat). (B) Tumor specimen (4 x 3 x 4 cm) was removed successfully with robot assisted resection.
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F3
Maryland bipolar forceps and monopolar curved scissors were employed as the left and right instruments, respectively (Fig. 3A). The left psoas muscle and ureter were noted beneath the transparent posterior peritoneum (Fig. 3A). After circumferential dissection, the tumor was excised with minimal traction of the originating nerve (Fig. 3B).