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Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps. Video can be found with this article online at https://ejgo.org/src/sm/jgo-30-e74-s001.mp4.
Mellie Heinemann1, 2
, Isabelle Masquin1, Guillaume Blache1, Laura Sabiani1, Camille Jauffret1, Gilles Houvenaeghel1, 2, Eric Lambaudie1, 2
, Isabelle Masquin1, Guillaume Blache1, Laura Sabiani1, Camille Jauffret1, Gilles Houvenaeghel1, 2, Eric Lambaudie1, 2
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
Notes
Conflict of Interest Eric Lambaudie and Gilles Houvenaeghel are proctor of Intuitive Surgical®. Other authors declare that there are no conflicts of interest.
Author Contributions
Conceptualization: H.M., B.G., S.L., J.C., H.G., L.E.
Funding acquisition: H.M.
Investigation: H.M.
Project administration: H.M.
Resources: H.M., M.I., L.E.
Software: H.M.
Supervision: H.M., M.I.
Validation: H.M., L.E.
Visualization: H.M.
Writing - original draft: H.M., M.I.
Writing - review & editing: H.M.
References
1. Lambaudie E, Narducci F, Leblanc E, Bannier M, Jauffret C, Cannone F, et al. Robotically assisted laparoscopy for paraaortic lymphadenectomy: technical description and results of an initial experience. Surg Endosc. 2012; 26:2430–2435.
2. Narducci F, Lambaudie E, Mautone D, Hudry D, Bresson L, Leblanc E. Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy in gynecologic oncology: preliminary experience and advantages and limitations. Int J Gynecol Cancer. 2015; 25:1494–1502.
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