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KMID : 1137020190300050074
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Journal of Gynecologic Oncology
2019 Volume.30 No. 5 p.74 ~ p.74
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Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps
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Heinemann Mellie
Masquin Isabelle
Blache Guillaume
Sabiani Laura
Jauffret Camille
Houvenaeghel Gilles
Lambaudie Eric
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Abstract
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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.
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KEYWORD
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Lymph Node Dissection, Remote Operation Robotics, Gynecologic Surgical Procedure, Oncology, Aortic
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