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Technique for precaval and laterocaval nodes excision at extraperitoneal paraaortic lymphadenectomy.

Abstract：

STUDY OBJECTIVE:To describe our technique for excision of the pre-caval and laterocaval nodes using an extraperitoneal approach. This technique was developed to make the dissection and excision of the less accessible nodes in an easier and safer way by minimizing the risk of great vessels injury and bleeding. DESIGN:Step-by-step description of the surgical procedure using video (Canadian Task Force classification III). SETTING:The procedure was performed at a teaching hospital, Hospital Universitario Donostia (Spain). PATIENTS:A 52-year-old woman with a body mass index of 33 underwent endoscopic extraperitoneal paraaortic lymphadenectomy for advanced high grade cervical adenocarcinoma FIGO IIB. INTERVENTIONS:The patient underwent an endoscopic extraperitoneal para-aortic lymphadenectomy. An anatomical dissection is being performed being the upper limit of the dissection the left renal vein. Focus of the video involves the challenging dissection of the right nodes. MEASUREMENTS AND MAIN RESULTS:Firstly we complete a dissection of all the anatomical aortic limits until the renal vein and exeresis of aortic nodes. A plane just above the cava vein is carefully developed by pushing all the lymph nodes to the roof of the dissection. Special care must be taken close to the aortic bifurcation due to the perforating vessels that can be found more frequently in this location. Once all this space is dissected, nodes attached to the roof are easily pushed down. It is useful to use a clip in the upper part, close to the renal vein, to prevent lymphorrhea. Nodes are excised in four blocks, supramesenteric and inframesenteric aortic and precaval nodes. The proximity to the peritoneal roof and the chance for a peritoneal hole and loss of pneumoperitoneum can be less problematic if the right dissection is performed at the end of the procedure. CONCLUSION:A complete para-aortic retroperitoneal dissection can be achieved with this extraperitoneal approach. Benefits of this technique are based on the absence of the bowel or other intraperitoneal structures invading the operative field given the barrier-free nature of the retroperitoneal space. Despite the challenge of the access to the right nodes in a retroperitoneal paraaortic lymphadenectomy they can be successfully excised reaching the renal vein including obese patients.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Gorostidi M,Villalain C,Ruiz R,Jaunarena I,Lekuona A

doi

10.1016/j.ygyno.2017.10.030

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

233-234

issue

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(17)31452-X

journal_volume

148

pub_type

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Technique for precaval and laterocaval nodes excision at extraperitoneal paraaortic lymphadenectomy.