Robotic retroperitoneal para-aortic lymphadenectomy via single-site port.

ABSTRACT

Para-aortic staging is sometimes a standard feature in the management of pelvic cancers. Minimal invasive approach is recommended. Several routes are possible extra-peritoneal or intraperitoneal depending on the expertise of the surgeon. We performed several extraperitoneal para-aortic lymphadenectomy using the Da Vinci Xi robotic system through single-site incision. We have developed a step-by-step guide from patient installation, installation of the Gelpoint V monotrocar, docking of the robot arms, to surgery, with the aim of performing the most efficient and safest procedure. The surgery does not differ from standard laparoscopic extraperitoneal lymphadenectomy. The advantages of minimally invasive robotic surgery in this indication are comparable to those of the standard laparoscopy approach. But through single-site incision, the Da Vinci Xi robot improves video quality, plus its wristed tools facilitates movements compared to conventional laparoscopy.