Journal List > J Gynecol Oncol > v.30(5) > 1129711

Heinemann, Masquin, Blache, Sabiani, Jauffret, Houvenaeghel, and Lambaudie: Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps



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].


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.


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


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.


Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps. Video can be found with this article online at


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.


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.

Mellie Heinemann

Isabelle Masquin

Guillaume Blache

Laura Sabiani

Camille Jauffret

Gilles Houvenaeghel

Eric Lambaudie

Similar articles