Transperitoneal laparoscopic staging with aortic and pelvic lymph node dissection for gynecologic malignancies
Section snippets
Equipment required
- (1)
5-mm trocars × 2, 10-mm blunt port (open laparoscopy), and 5/12-mm trocar (Fig. 1);
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monopolar electrosurgical unit or 10-mm argon beam coagulator set at 70 W with gas flow rate at 3–4 L/min;
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5-mm vessel sealing devise;
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5-mm graspers × 2, 10-mm lymph node spoon;
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5-mm and 10-mm laparoscopic clip appliers;
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Suction irrigation; and
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4 × 8 gauze.
Procedure
The paraaortic lymph node dissection is performed first. The patient is placed in the dorsal lithotomy position with the legs in the universal Allen stirrups. A Foley catheter is inserted. An open laparoscopy technique is performed and the blunt port is inserted into the umbilicus. Five-millimeter trocars are placed medial to the iliac crest, usually 1 cm superiorly and 1 cm medially, avoiding the abdominal wall vasculature. A 5/10 or 5/12 mm trocar is placed in the suprapubic area.
Bilateral paraaortic lymphadenectomy
The camera is placed in the suprapubic port. The surgeon stands on the patient's right-hand side and operates with the argon beam coagulator or other surgical device placed in the umbilical region and a 5-mm grasper in the left hand through the right lower quadrant 5-mm trocar. The assistant stands on the patient's left side holding the camera with the left hand in the suprapubic port and holding a grasper with the right hand through the left lower quadrant 5-mm trocar. The right paraortic
Bilateral pelvic lymphadenectomy
The pelvic lymphadenectomy is started by developing the paravesical and pararectal space. The round ligament is divided. The umbilical ligament is isolated. A retroperitoneal incision between the round ligament and the umbilical ligament parallel to the umbilical ligament is performed and extended just to the reflection of the interior abdominal wall. The umbilical ligament is then placed on traction medially, and the paravesical space is developed to expose the external iliac vessels, the
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Cited by (11)
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2011, Gynecologic OncologyCitation Excerpt :The concept of minimally invasive surgery in the management of gynecologic malignancies has gone from a perceived near impossibility to a fully realized surgical option for many patients over the last 15 years. The growing use of laparoscopic surgery in the management of gynecologic malignancies has become evident [6–9]. Most laparoscopic lymphadenectomies reported in the literature are performed transperitoneally.
Trends in laparoscopic and robotic surgery among gynecologic oncologists: A survey update
2009, Gynecologic OncologyCitation Excerpt :Over the last decade, gynecologic oncologists have increasingly used minimally invasive techniques to resect and stage gynecologic cancers. Multiple studies have described the feasibility, efficacy, safety, and adequacy of this surgical approach in the management of gynecologic malignancies [1–5]. More recently, robot-assisted management of gynecologic malignancies has been described as a promising new technique that may overcome the surgical limitations seen with conventional laparoscopy [6,7].
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