Laparoscopic Paraaortic Lymph Node Dissection in Patients with Gynecologic Malignancies

Accurate evaluation of the paraaortic lymph node is important in planning treatment of gynecologic malignancies. Because radiologic methods to detect occult paraaortic lymph node metastases are inaccurate and staging requires a major surgical procedure, we investigated the feasibility of laparoscopic paraaortic lymph node dissection in our preliminary series of five women (3 stage IIb cervical cancer, 1 stage Ib cervical cancer, 1 ovarian cancer). Three patients with stage Ib cervical cancer scheduled for primary radiotherapy underwent selective paraaortic lymph node biopsy only. We performed laparoscopic radical hysterectomy with pelvic lymphadenectomy in the patient with stage Ib disease, in addition to paraaortic lymph node dissection. The average operating time for lymph node dissection was 125 minutes and mean estimated blood loss was 250 ml. The average number of lymph nodes removed was 3.6. We conclude that this laparoscopic procedure is feasible and helps guide the management of these patients.