Single port laparoscopy and extraperitoneal para-aortic lymphadenectomy
Epublication WebSurg.com, Feb 2014;14(02). URL: http://websurg.com/doi/vd01en4167
Background: To report the feasibility and reproducibility of single port extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer before chemoradiotherapy. This procedure is used in our institution in patients with negative PET-CT imaging in the para-aortic area to define radiation field limits more accurately. Methods: Prospective study of patients with stage IB1N+-IVA cervical cancer treated at the Institute Gustave Roussy from January 2011 to January 2013. Results: There was no conversion to laparotomy or to conventional multiport laparoscopy among our 50 cases. Only one failure occurred after removal of 2 nodes. In this case, we chose to stop the procedure because of the risk of a vascular complication due to the vascular anatomic variation. The median and mean number of lymph nodes removed were 18 [2-47] and 19 respectively. Six (12%) patients had metastatic para-aortic nodes. Radiotherapy fields were extended when para-aortic nodes were involved. Conclusion: Extraperitoneal staging via a single port left iliac approach is feasible with conventional tools; it is reproducible and safe, and offers a high degree of cosmetic satisfaction.