Laparoscopic en bloc resection of obturator lymph node: a surgical education video

Surgery serves as a crucial therapeutic modality for gynecological malignancies, occupying a central role in the multimodal treatment framework for common gynecological cancers including cervical cancer, ovarian cancer, endometrial cancer, and vulvar cancer. Its clinical value extends across the early, middle, and advanced stages of tumors, encompassing multiple therapeutic objectives such as radical resection, cytoreductive therapy, and palliative relief. This video showcases the laparoscopic en bloc excision of enlarged obturator lymph nodes, focusing on key technical strategies for safe and effective dissection in the complex pelvic anatomical region-where close proximity to critical structures like the obturator nerve and iliac blood vessels poses inherent risks. The patient was initially planned for laparoscopic total hysterectomy due to cervical intraepithelial neoplasia grade III (CIN III), with no preoperative imaging or clinical indicators suggesting the need for lymphadenectomy. During the procedure, the surgical team unexpectedly identified enlarged, firm obturator lymph nodes, which postoperative pathological analysis confirmed as metastases from urethral squamous cell carcinoma-a known primary tumor prone to pelvic lymph node spread. The surgical approach prioritized meticulous anatomical landmark identification (including the obturator nerve and vascular bundles), strict adherence to fascial plane boundaries, and combined use of blunt dissection and precise suturing. These techniques minimized the risk of vascular injury and nerve palsy, common complications in pelvic lymphadenectomy. This case underscores the feasibility and safety of laparoscopic management for complex pelvic lymphadenopathy when guided by refined surgical skills, leveraging the technology's high-definition visualization advantage. As a medical educational resource, the video aims to equip surgeons with practical insights to enhance their technical proficiency in dissecting lymph nodes within high-risk anatomical areas, supporting improved intraoperative decision-making and patient outcomes.