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Role of para-aortic staging lymphadenectomy in advanced cervical cancer (update of September 2014 lecture)
Pelvic and para-aortic lymph node evaluation is a major component of the surgical staging procedure for several gynecologic malignancies. Cervical cancer is clinically staged, but assessment of pelvic and para-aortic lymph nodes is performed with lymphadenectomy and/or imaging. The surgical and oncologic goals of lymph node dissection are to define the extent of disease, and thereby, to guide further treatment. Lymphadenectomy may also have a therapeutic goal in conditions in which removing nodes harboring metastatic disease improves survival. The role of para-aortic lymph node dissection for women diagnosed with LACC had been described in these slides.
F Kridelka
Lecture
2 years ago
1429 views
123 likes
0 comments
27:54
Role of para-aortic staging lymphadenectomy in advanced cervical cancer (update of September 2014 lecture)
Pelvic and para-aortic lymph node evaluation is a major component of the surgical staging procedure for several gynecologic malignancies. Cervical cancer is clinically staged, but assessment of pelvic and para-aortic lymph nodes is performed with lymphadenectomy and/or imaging. The surgical and oncologic goals of lymph node dissection are to define the extent of disease, and thereby, to guide further treatment. Lymphadenectomy may also have a therapeutic goal in conditions in which removing nodes harboring metastatic disease improves survival. The role of para-aortic lymph node dissection for women diagnosed with LACC had been described in these slides.
Single port laparoscopy and extraperitoneal para-aortic lymphadenectomy
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.
S Gouy, C Uzan, A Leary, P Morice
Surgical intervention
5 years ago
2459 views
43 likes
0 comments
09:54
Single port laparoscopy and extraperitoneal para-aortic lymphadenectomy
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.
Lumbo-aortic lymphadenectomy: improving exposure with the T’lift™ device
Lymph node dissection in the lumbo-aortic area is a challenging procedure. The main concerns during surgery include the risk of major vascular injury and the potential lesion of other structures such as the ureter or the duodenum. A thorough surgical strategy and adequate exposure are mandatory to reduce the possibility of complications.
During this surgical demonstration, the most important aspects of the strategy are discussed. Special emphasis is put on exposure and the use of the T’lift™ device is shown. This simple technique allows for a fast and safe suspension of the peritoneum, improving the visualization of the operative field.
A Wattiez, M Puga, CY Akladios, C Redondo Guisasola, Al Ussia
Surgical intervention
6 years ago
4301 views
59 likes
0 comments
15:01
Lumbo-aortic lymphadenectomy: improving exposure with the T’lift™ device
Lymph node dissection in the lumbo-aortic area is a challenging procedure. The main concerns during surgery include the risk of major vascular injury and the potential lesion of other structures such as the ureter or the duodenum. A thorough surgical strategy and adequate exposure are mandatory to reduce the possibility of complications.
During this surgical demonstration, the most important aspects of the strategy are discussed. Special emphasis is put on exposure and the use of the T’lift™ device is shown. This simple technique allows for a fast and safe suspension of the peritoneum, improving the visualization of the operative field.
Retroperitoneal laparoscopic para-aortic lymphadenectomy: stage IIB cervical carcinoma
This video demonstrates a retroperitoneal para-aortic lymphadenectomy for stage IIB epidermoid cervical carcinoma. This procedure allows to identify patients who should undergo extended field radiotherapy. The intervention is pursued with the dissection of the lympho-adipose tissue situated in the following anatomical boundaries: ureters and psoas muscles laterally, the iliac artery bifurcation —lower limit— and the left renal vein —superior limit. A diagnostic laparoscopy is first performed to rule out metastasis. A 10mm, 0-degree scope is used. An umbilical Hasson trocar is placed to explore the abdominal cavity. A left McBurney’s incision is then made, and the retroperitoneal space is created digitally. The Hasson trocar is placed with a 10mm balloon through the anterior incision. Two additional ports are placed in the anterior axillary line, a 12mm one and a 5mm one. The 5mm Ligasure™ V device and a grasping forceps are used throughout the whole intervention. At the end of the procedure, the lympho-adipose tissue is extracted using an Endobag through an enlarged peritoneal opening.
H Di Fiore, O Martínez, I Pérez, I Borrego, A Cristóbal
Surgical intervention
8 years ago
919 views
51 likes
0 comments
14:47
Retroperitoneal laparoscopic para-aortic lymphadenectomy: stage IIB cervical carcinoma
This video demonstrates a retroperitoneal para-aortic lymphadenectomy for stage IIB epidermoid cervical carcinoma. This procedure allows to identify patients who should undergo extended field radiotherapy. The intervention is pursued with the dissection of the lympho-adipose tissue situated in the following anatomical boundaries: ureters and psoas muscles laterally, the iliac artery bifurcation —lower limit— and the left renal vein —superior limit. A diagnostic laparoscopy is first performed to rule out metastasis. A 10mm, 0-degree scope is used. An umbilical Hasson trocar is placed to explore the abdominal cavity. A left McBurney’s incision is then made, and the retroperitoneal space is created digitally. The Hasson trocar is placed with a 10mm balloon through the anterior incision. Two additional ports are placed in the anterior axillary line, a 12mm one and a 5mm one. The 5mm Ligasure™ V device and a grasping forceps are used throughout the whole intervention. At the end of the procedure, the lympho-adipose tissue is extracted using an Endobag through an enlarged peritoneal opening.