Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1499-1507
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1499
Removal of pediatric stage IV neuroblastoma by robot-assisted laparoscopy: A case report and literature review
Di-Xiang Chen, Yi-Han Hou, Ya-Nan Jiang, Li-Wei Shao, Shan-Jie Wang, Xian-Qiang Wang
Di-Xiang Chen, Xian-Qiang Wang, Department of Pediatrics, PLA General Hospital, Beijing 100853, China
Yi-Han Hou, Ya-Nan Jiang, Beijing University of Chinese Medicine, Beijing 100029, China
Li-Wei Shao, Department of Pathology, PLA General Hospital, Beijing 100853, China
Shan-Jie Wang, Department of Hepatobiliary Disease, Sixth People’s Hospital of Jinan Affiliated to Jining Medical School, Jinan 250200, Shandong Province, China
Author contributions: Chen DX and Hou YH contributed equally to this article and should be considered as co-first authors. Chen DX, Hou YH, Wang SJ, and Wang XQ designed this case report; Hou YH, Jiang YN, Shao LW, and Wang XQ wrote the manuscript.
Supported by the PLA General Hospital Clinical Support Grant, No. 2017FC-TSYS-3031 and No. 2017FC-TSYS-3010.
Informed consent statement: The patient provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xian-Qiang Wang, MD, PhD, Assistant Professor, Department of Pediatrics, PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
Telephone: +86-13522891848 Fax: +86-10-66938418
Received: February 16, 2019
Peer-review started: February 18, 2019
First decision: April 18, 2019
Revised: April 29, 2019
Accepted: May 11, 2019
Article in press: May 11, 2019
Published online: June 26, 2019

Neuroblastoma (NB) is the most common extracranial solid tumor in children, with an incidence of approximately 1/10000. Surgical resection is an effective treatment for children with NB. Robot-assisted laparoscopic surgery is a new method and is superior to conventional laparoscopic surgery, since it has been preliminarily applied in clinical practice with a significant curative effect. This paper discusses significance and feasibility of complete resection of stage IV NB using robot-assisted laparoscopic surgery, while comparing its safety and effectiveness with conventional laparoscopic surgery.


In June 2018, a girl with stage IV retroperitoneal NB, aged 3 years and 5 mo, was admitted. Her weight was 15 kg, and her height was 100 cm. Robot-assisted, five-port laparoscopic resection of NB was performed. Starting from the middle point between the navel and the anterior superior iliac spine to the left lower abdomen, the pneumoperitoneum and observation hole (10 mm) were established using the Hasson technique. Operation arm #1 was located between the left anterior axillary line, the navel, and the costal margin (8 mm); operation arm #2 was located at the intersection of the right anterior axillary line and Pfannenstiel line (8 mm); one auxiliary hole was located between arm #2 (on the Pfannenstiel line) and the observation hole (12 mm); and another auxiliary hole (5 mm) was located slightly below the left side of the xiphoid. Along the right line of Toldt and the hepatic flexure of the transverse colon, the colon was turned to the left and below with a hook electrode. Through Kocher's incision, the duodenum and the pancreatic head were turned to the left to expose the inferior vena cava and the abdominal aorta. The vein was separated along the right external iliac, and the inferior vena cava was then lifted to expose the right renal vein from the bottom to the top. The tumor was transected horizontally below the renal vein, and it was first cut into pieces and then resected. The right renal artery and the left renal vein were also exposed, and the retrohepatic inferior vena cava was isolated. The tumor was resected along the surface of the psoas muscle, the back of the inferior vena cava, and the right side of the abdominal aorta. Finally, the lymph node metas-tases in front of the abdominal aorta and left renal vein were completely removed. The specimens were loaded into a disposable specimen retrieval bag and removed from the enlarged auxiliary hole. T-tube drainage was placed and brought out through a hole in the right lower quadrant of the abdomen. The operative time was 389 min, the time of pneumoperitoneum was 360 min, the intraoperative blood loss was approximately 200 mL, and the postoperative recovery was smooth. There were no complications, such as lymphatic fistula, diarrhea, bleeding, and paralytic ileus. Two months after discharge, there were no other complications. The literature on the application of robot-assisted laparoscopic surgery in the treatment of NB in children was reviewed


The robot has the advantages of a three-dimensional view and flexible operation, and it can operate finely along blood vessels. The successful experience of this case confirmed that robot-assisted laparoscopic surgery can skeletonize the abdominal blood vessels in the tumor and cut the tumor into pieces, indicating that robot-assisted laparoscopic surgery is feasible.

Keywords: Robot-assisted surgery, Retroperitoneal neuroblastoma, Children, Case report

Core tip: Our paper describes the key surgical points in pediatric stage IV neuroblastoma that was completely resected using the Da Vinci robotic system. An adrenalectomy was carried out for a girl aged 3 years and 5 months by robot-assisted laparoscopic surgery at our hospital, and then systematic literature review was done to discuss the significance and feasibility of complete resection of stage IV neuroblastoma, the surgical safety and advantages, and the safety and effectiveness of robot-assisted surgery compared with traditional laparoscopic surgery.