J Gynecol Oncol.  2018 Nov;29(6):e87. 10.3802/jgo.2018.29.e87.

Robotic lower pelvic port placement for optimal upper paraaortic lymph node dissection

Affiliations
  • 1Department of Gynecology Oncology and Robotic Surgery, Center of Hope, University of Nevada, Reno School of Medicine, Reno, NV, USA. pclimmd@centerofhopereno.com
  • 2Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.

Abstract


OBJECTIVE
Upper paraaortic lymph node dissection (UPALD) to the infrarenal level is one of the most challenging robotic procedures. Because robotic system has the limitation in robotic arm mobility. This surgical video introduces a novel robotic approach, lower pelvic port placement (LP3), to perform optimally and simultaneously both UPALD and pelvic procedures in gynecologic cancer patients using da Vinci Xi system.
METHODS
The patient presented with high-grade endometrial cancer. She underwent robotic surgical staging operation. For the setup of the LP3, a line was drown between both anterior superior iliac spines. At 3 cm below this line, another line was drown and four robotic ports were placed on this line.
RESULTS
After paraaortic lymph node dissection (PALD) was completed, the boom of robotic system was rotated 180° to retarget for the pelvic lateral displacement. Robotic ports were placed and docked again. The operation was completed robotically without any complication.
CONCLUSION
The LP3 was feasible for performing simultaneously optimal PALD as well as procedures in pelvic cavity in gynecologic cancer patients. The advantage of LP3 technique is the robotic port placement that affords for multi-quadrant surgery, abdominal and pelvic dissection. The LP3 is facilitated by utilizing advanced technology of Xi system, including the patient clearance function, the rotating boom, and "˜port hopping' that allows using every ports for a camera. The LP3 will enable surgeons to extend the surgical indication of robotic surgical system in the gynecologic oncologic field.

Keyword

Robotic Surgical Procedures; Lymph Node Excision

MeSH Terms

Arm
Endometrial Neoplasms
Female
Humans
Lymph Node Excision*
Lymph Nodes*
Robotic Surgical Procedures
Spine
Surgeons
Full Text Links
  • JGO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr