Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis

Li, Kunpeng; Deng, Xianzhong; Wu, Tao

doi:10.3389/fsurg.2021.779372

Cited by 1 publication

(2 citation statements)

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“…Previous meta-analyses have reported that the ELPAN technique has certain advantages when compared with transperitoneal laparoscopic para-aortic lymphadenectomy (6,7). For example, the ELPAN technique makes it easier for the surgeon to approach the lymph nodes on the left side of the large vessels and can be easily applied in cases that involve intra-abdominal adhesions.…”

Section: Discussionmentioning

confidence: 99%

“…Previous meta-analyses compared para-aortic lymphadenectomy using the extraperitoneal laparoscopic approach (ELPAN) with transperitoneal laparoscopic approaches in patients with endometrial cancer and reported that the ELPAN led to the successful harvesting of a higher number of para-aortic lymph nodes (6,7). In addition, the left-sided extraperitoneal technique was found to facilitate easy access to the left aortic nodes, which comprise 63% of all aortic nodes (8,9).…”

Section: Introductionmentioning

confidence: 99%

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Surgical training in extraperitoneal laparoscopic para‑aortic lymphadenectomy for the treatment of gynecological cancer using a Thiel‑embalmed cadaver

Nagao,

Andou,

Irie

et al. 2024

Oncol Lett

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The extraperitoneal laparoscopic approach (ELPAN) for para-aortic lymphadenectomy provides excellent visibility of the left side of the aorta, thus facilitating surgery in the retroperitoneal space. This technique is highly complex compared with the transperitoneal approach. In particular, advanced techniques are required to develop an appropriate surgical field in the narrow retroperitoneal space; therefore, surgeons need to undergo a significant amount of training to become competent. A variety of tools are available for surgical training but are limited by their ability to reproduce complex anatomy. Thus, cadavers may represent the most suitable tool for learning this unique technique. The present study describes a surgical training protocol for the ELPAN technique using a Thiel-embalmed human cadaver and provides a step-by-step description of the ELPAN technique performed at Okayama University (Okayama, Japan). A 72-year-old Thiel-embalmed female cadaver was used to develop a protocol for surgical training in the ELPAN technique that effectively reproduced the methodology required in clinical practice. A training method for ELPAN surgery was developed and successfully completed using the Thiel-embalmed cadaver that secured the surgical field in the retroperitoneal space and permitted resection of the lymph nodes. The Thiel-embalmed cadaver tissue possessed excellent properties for surgical training, including color tone, flexibility, and the membrane structure of connective and fat tissues. In addition, this method of fixation preserved stiffness and elasticity of the peritoneum, although large vessels were slightly fragile and poorly extensible. Surgical training using a Thiel-embalmed human cadaver represents a valuable option for learning the ELPAN surgical technique. However, this technique may be unsuitable for training in perivenous manipulation. To the best of our knowledge, this is the first report to describe the use of Thiel-embalmed cadavers as a tool for surgeons to undergo training in the ELPAN technique.

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Section: Discussionmentioning

confidence: 99%