Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps.

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. 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.