Left-sided suprarenal retrocrural para-aortic lymphadenectomy in advanced cervical cancer by laparoscopy

Conventional open suprarenal retrocrural lymphadenectomy is done via a thoraco-abdominal approach including partial rib resection. We developed a less invasive technique.

Through a laparoscopic transperitoneal approach the left paracolic peritoneum and the left phrenicocolic ligament are transected. The colonic flexure, left kidney with adrenal, tail of the pancreas, and spleen are mobilized and retracted medially. The suprarenal aorta with superior mesenteric artery and coeliac trunk are exposed. The crus of the diaphragm and the right inferior phrenic artery are transected. This allows lymphadenectomy from the level of the left renal vessels to the crus of the diaphragm.

In October 1997 three women with cervical cancer stage IIIB underwent laparoscopic suprarenal retrocrural lymphadenectomy. A mean of 10 lymph nodes was removed (range 8-12). Duration of operation was on average 218 min (range 196-258 min). Intraoperative blood loss was estimated between 100 and 400 ml and hospital stay was 4 days on average. There were no intra- or postoperative complications.

This laparoscopic technique may prove useful for staging and treatment of women with advanced gynecologic cancer.