Extraperitoneal Para-Aortic Lymphadenectomy by Robot-Assisted Laparoscopy.
J Minim Invasive Gynecol
; 25(5): 861-866, 2018.
Article
en En
| MEDLINE
| ID: mdl-29337211
ABSTRACT
STUDY OBJECTIVE:
To evaluate the outcomes of extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy.DESIGN:
A retrospective study (Canadian Task Force classification III).SETTING:
An academic institution. PATIENTS Twenty-three consecutive patients with gynecologic cancer who presented for para-aortic lymphadenectomy between March 2016 and May 2017 were reviewed retrospectively.INTERVENTIONS:
Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was performed. MEASUREMENTS AND MAINRESULTS:
Of the 23 patients reviewed retrospectively, 10 had cervical cancer, 7 had endometrial cancer, 5 had adnexal cancer, and 1 had vaginal cancer. Data regarding patient characteristics, indication for para-aortic lymphadenectomy, type of surgery (infrarenal or inframesenteric), operative time, surgical complications, number of nodes retrieved, and postoperative hospital length of stay were collected. Two patients were excluded because of early perforation of the peritoneum. In total, 21 para-aortic lymphadenectomies were performed (16 infrarenal and 5 inframesenteric). The median skin-to-skin operating time of infrarenal extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was 170 minutes (range, 90-225 minutes), the median lymph node count was 18 (range, 11-38), and the median estimated blood loss was 50 mL (range, 10-600 mL). The median skin-to-skin operating time of inframesenteric extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was 120 minutes (range, 90-220 minutes), the median lymph node count was 10 (range, 7-19), and the median estimated blood loss was 30 mL (range, 10-100). Intraoperative complications included 1 thermal lesion of the left genitofemoral nerve, 1 thermal lesion of the left mesoureter (a ureteral stent was placed to avoid ureteric necrosis and fistula without after effect), and 1 lesion of the inferior vena cava that was sutured by robot-assisted laparoscopy. There were 2 additional cases of perforation of the peritoneum that occurred in the infrarenal group. The median hospital length of stay was 1 day (range, 0-7 days). Three patients were readmitted for symptomatic lymphocysts.CONCLUSION:
Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy provides good visualization of the operative field without arm conflict. Still, perforation of the peritoneum and symptomatic lymphocysts are a postoperative concern.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Laparoscopía
/
Procedimientos Quirúrgicos Mínimamente Invasivos
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Cirugía Asistida por Computador
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Procedimientos Quirúrgicos Robotizados
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Neoplasias de los Genitales Femeninos
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Escisión del Ganglio Linfático
Tipo de estudio:
Observational_studies
Límite:
Adult
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Aged
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Female
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Humans
/
Middle aged
Idioma:
En
Revista:
J Minim Invasive Gynecol
Asunto de la revista:
GINECOLOGIA
Año:
2018
Tipo del documento:
Article