A modified technique to perform para-aortic lymphadenectomy up to the renal vein

Abstract

Objective: To investigate the safety and feasibility of our modified technique to perform lymph node excision up to the renal vein in cases of gynecological cancer. Materials and methods: 87 patients with endometrial or ovarian neoplasms underwent laparoscopic para-aortic lymphadenectomy (LPAL) up to the left renal vein were enrolled prospectively. During surgery, the surgeon was positioned to the right side of the patient and an additional trocar was introduced into the upper right abdomen. The laparoscopic video screen was placed to the side of the patient's head. Three-fan retractor forceps were used to hold up the duodenum and small bowel. The rest of the procedure was the same as conventional LPAL. Results: The median operating time for LPAL was 72 min (range: 40–115 min) and the median estimated blood loss was 45 ml (range: 15–1000 mL). There were two cases of intra-operative vascular injury. The median number of retrieved para-aortic lymph nodes (PALNs) was 18 (range: 10–37). Of the 87 patients, 11 patients had positive PALNs. None of the cases required laparotomy. Conclusion: Our findings demonstrate that our modified LPAL technique is feasible, reproducible, can achieve good exposure and reduces surgical difficulty.

Keywords

• Endometrial neoplasms
• Laparoscopy
• Lymph node excision
• Ovarian neoplasms
• Renal veins