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Robot-assisted total extraperitoneal para-aortic and pelvic lymphadenectomy
Shiori Yanai1, Kiyoshi Kanno1, Shintaro Sakate1
1Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.
Gynecologic Oncology Reports
|May 24, 2021
Summary
Robot-assisted extraperitoneal lymphadenectomy is a safe and feasible surgical option for gynecologic cancer patients, especially those with abdominal adhesions. This minimally invasive approach avoids the Trendelenburg position, benefiting patients with comorbidities.
Area of Science:
- Gynecologic Oncology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robot-assisted extraperitoneal para-aortic lymphadenectomy has demonstrated feasibility for gynecologic malignancies.
- Previous studies have reported laparoscopic extraperitoneal total para-aortic and pelvic lymphadenectomy.
Purpose of the Study:
- To demonstrate the safety of robot-assisted extraperitoneal total para-aortic and pelvic lymphadenectomy.
- To present the surgical management of a patient with suspected stage IA ovarian clear cell carcinoma.
Main Methods:
- Robot-assisted extraperitoneal total para-aortic and pelvic lymphadenectomy was performed in a 67-year-old woman with predicted abdominal adhesions.
- The procedure involved docking three robot arms, using a bipolar cutting method, and performing lymphadenectomy up to the renal veins and down to the obturator muscles.
- An AirSeal® port was utilized, and the surgery was completed with an omentectomy.
Main Results:
- The operative time was 189 minutes with an estimated blood loss of 75 ml.
- A total of 56 lymph nodes were harvested: 22 para-aortic and 34 pelvic.
- The procedure was completed successfully without complications.
Conclusions:
- Robot-assisted extraperitoneal lymphadenectomy is a feasible and safe procedure for gynecologic cancer staging.
- This technique, not requiring Trendelenburg positioning and avoiding bowel obstruction, is suitable for patients with hypertension, glaucoma, obesity, or abdominal adhesions.
