Introduction/Background Laparoscopic para-aortic lymphadenectomy (L-PALA) for patients with endometrial cancer has been performed in some hospital (lees than 30) in Japan. To perform the surgery safely, it is important to avoid injuries against organs such as ureter, inferior mesenteric artery, duodenum, left renal vein.
Methodology The indication of L-PALA in our hospital was endometrioid carcinoma (EM) of grade 3 and serous, clear cell carcinoma, carcinosarcoma or more than half myometrial invasion from an intraoperative frozen section diagnosis and a tumor clinically confined to the uterus (clinical stage I) based on a pre-operative evaluation.
Lymphatic tissues were resected from the anterior, lateral, and medial aspects of the aorta and vena cava to the level of the renal veins after total hysterectomy (TH), bilateral salpingo-oophorectomy (BSO) and pelvic lymphadenectomy (PLA).
There are three tips to avoid injuries in operating field of L-PALA.
Tip1: Dissection bilateral ureter the cranial level of aorta during performing PLA.
Tip2: Confirmation of fellow’s vein in front of vena cava.
Tip3: Lifting up duodenum sufficiently with wide instrument.
We show these tips with this video.
Results We have performed the surgery for 11 cases since 2018. The post-operative stage of them was 1A: 8, 1B: 2, 3C2: 1. Histopathologically, they had EM G1:1, EM G2:3, EM G3:1, and others:6. The median age was 60 y.o. (52–70), Body mass index (BMI) 22 (18–27), operative time 443 min. (393–501), blood loss 75 ml (0–421).
The median number of resected pelvic and para-aorta lymph nodes was 58 (34–86) and 31 (13–53).
There was no blood transfusion, organ injuries, surgical site infection, pelvic peritonitis, and ileus.
Conclusion The rate of peri- and post-operative complications was very low.
Our laparoscopic surgery with para-aortic lymphadenectomy for early-stage endometrial cancer is safe and minimally invasive in our opinion.
Disclosure Nothing to disclose
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