Laparoscopic technique of para-aortic lymph node dissection: A comparison of the different approaches to trans- versus extraperitoneal para-aortic lymphadenectomy

Abstract

Since Dr Dargent first reported endoscopic surgery using retroperitoneal pelvicoscopy to perform pelvic lymph node sampling in 1987, many literature reviews on the safety and feasibility of laparoscopic staging surgery of gynecologic malignancies have been published. However, the procedure of laparoscopic lymphadenectomy is more difficult to perform due to the limited surgical space and associated technical problems. Especially in the para-aortic lymphadenectomy procedure, there are many barriers to overcome in the surgical field, learning curve, and technique. We present a review of lymphadenectomy, especially para-aortic lymphadenectomy.

Transperitoneal Versus Extraperitoneal Laparoscopic Lymphadenectomy for Gynecological Malignancies: A Systematic Review and Meta-analysis

“…The ELL technique provides a more secure access to the left aortic lymph nodes and specifically to challenging-to-reach supramesenteric lymph nodes. Additionally, the bowel does not interfere with the surgical field and the left ureter is always in sight and thus reduces the risk of injury to these structures (21). The ELL approach eliminates the risk of postoperative abdominal hernia and intra-abdominal adhesions, since the peritoneal cavity remains intact (23).…”

Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

“…The FIGO 2009 Staging stratified Stage IIIC into Stage IIIC1 (PLN+) and Stage IIIC2 (PAN+ ± PLN+) by the presence of para-aortic lymph node metastasis, indicating a worse prognosis with PAN involvement (5)(6)(7). The most common LNM patterns are well-recognized as PLN+PAN-and PLN+PAN+, since the reported incidence of isolated para-aortic lymph node Abbreviations: CECC, Chinese Endometrial Carcinoma Consortium; DSS, disease-specific survival; EC, endometrial cancer; FIGO, International Federation of Gynecology and Obstetrics; HR, Hazard ratio; LNM, lymph node metastasis; LVSI, lymphovascular space involvement; NCCN, National Comprehensive Cancer Network; OS, overall survival; PAN, para-aortic lymph node; PAN+, paraaortic lymph node metastasis; PLN, pelvic lymph node; PLN+, pelvic lymph node metastasis; PLN-PAN+, PAN metastasis without PLN metastasis; PLN+PAN-, PLN metastasis without PAN metastasis; PLN+PAN+, both PLN and PAN metastasized; RFS, relapse-free survival; SLN, sentinel lymph node.…”

A retrospective study of a novel non-umbilical laparoscopic entry port in thin patients—Jain point

“…Lee Huang's point (Fig. 1) is also a non-umbilical entry port which is well indicated for cases in malignancy for para-aortic lymph node dissection [45] and large masses. But most of the concerns for Palmer's point hold true for this port also.…”