J Gynecol Oncol.  2019 Sep;30(5):e74. 10.3802/jgo.2019.30.e74.

Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps

• Heinemann
• Masquin I
• Blache G
• Sabiani L
• Jauffret C
• Houvenaeghel G
• Lambaudie

• KMID: 2457152
• DOI: http://doi.org/10.3802/jgo.2019.30.e74

Abstract

OBJECTIVE
Para-aortic lymphadenectomy was the cornerstone of gynecologic oncology surgery. In endometrial cancer, the quality of para-aortic lymphadenectomy had direct impact on survival of patient. The launch of robot assisted laparoscopy started in 2005 in France, and in 2008 a transperitoneal para-aortic lymphadenectomy was described [1]. With the increase of robots, the robot assisted laparoscopy became more and more popular, hence the need of video tutorial to help less experienced surgeon in this surgical procedure [2].
METHODS
We proposed a description in 10 key steps, of a transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy (Da Vinci® Si or Xi Robot Surgical System; Intuitive Surgical Inc., Sunnyvale, CA, USA), without other surgical procedure.
RESULTS
The 10 steps are: Step 1: port placement and Da Vinci robot positioning Step 2: identification of the right ureter Step 3: identification of the left renal vein Step 4: latero-caval and aorto-caval lymph nodes dissection Step 5: identification of the left ureter Step 6: creation of peritoneal tent Step 7: identification of the inferior mesenteric artery Step 8: latero-aortal lymph nodes dissection Step 9: pre-sacral lymph nodes dissection Step 10: extraction of bags with specimen and surgical textile
CONCLUSION
A standardization of transperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy is the basis of teaching and learning process. Also it increases the quality of surgery, and consequently decreases the risk of complications.

Keyword

Lymph Node Dissection; Remote Operation Robotics, Gynecologic Surgical Procedure; Oncology; Aortic

MeSH Terms

Endometrial Neoplasms
Female
France
Humans
Laparoscopy*
Learning
Lymph Node Excision*
Lymph Nodes
Mesenteric Artery, Inferior
Renal Veins
Textiles
Ureter