Surgical advantages of laparoscopic pelvic and para-aortic lymph node dissection using the thermal welding instrument compared with conventional laparotomy for lymph node dissection

Abstract

Objectives: We sought to evaluate the feasibility of laparoscopic pelvic lymph node dissection (PLND) and para-aortic lymph node dissection (PALND) using a thermal ligating shears (TLS) thermal welding instrument comparing with the conventional laparotomic PLND and PALND in the management of endometrial cancer. Materials and methods: The current study retrospectively reviewed 100 patients who underwent TLS laparoscopic PLND and PALND and 20 patients who underwent abdominal PLND and PALND as a control group between July 2003 and December 2008. The surgical parameters were compared between the groups. Results: In the TLS laparoscopic group, 73 patients underwent PLND and 27 patients underwent PLND and PALND; in the conventional laparotomic group, nine patients underwent PLND and 11 patients underwent PLND and PALND. Compared to the laparotomic group, the surgical parameters of the laparoscopic group including mean operating time (52 minutes vs. 76 minutes, p < 0.005), mean blood loss (64 mL vs. 162 mL, p = 0.0001), and mean hospital stay (3.96 days vs. 8.92 days, p = 0.001) were all decreased significantly. A significant difference was also found between groups in total number of pelvic (47.6 vs. 35.7, p < 0.05) and aortic (8.4 vs. 6.5, p < 0.05) lymph nodes dissected. Conclusion: The data demonstrate that lymph node dissection could be performed effectively by laparoscopy with the thermal welding instruments with a greater number of retrieved lymph nodes, less blood loss, and shorter hospital stay.

Keywords

• Endometrial cancer
• Laparoscopy
• Laparotomy
• Lymphadenectomy