Introduction/Background To describe surgical approach and strategy in the excision of enlarged paraaortic node by laparoscopy.

Video presentation offers a thorough review of CT images and its correspondence with anatomical findings in surgery, permitting a complete view of retroperitoneal anatomy.

Methodology Case report of 86-year-old woman presenting 2 month history of abdominal pain which leads to detection by imaging tests of multilocular solid cyst in left ovary and a suspicious node situated above left renal vein without peritoneal carcinomatosis signs.

CT shown two vascular anomalies in the paraaortic area consisting on a retroaortic left renal vein and a polar artery, in between of which, bulky node was described.

After Oncology-Gynaecology Committee evaluation, a laparoscopic approach was performed to undertake adequate staging and complete cytoreduction.

Results Abdominal cavity exploration was performed confirming enlarged left ovarian and no peritoneal carcinomatosis signs.

An extraperitoneal laparoscopic approach was chosen to get access to the bulky node; permitting more secure access to left paraaortic zone and less bowel interference. After retroperitoneal space creation, establishment of anatomical landmarks was determined as first step. Dissection of anterior aspect of the aorta allowed identification of the anatomical variations described on CT and the enlarged node, which was carefully dissected. Due to anatomopathological study confirmation of ovarian cancer metastasis; hysterectomy, bilateral adnexectomy, omentectomy and systematic paraaortic and pelvic lymphadenectomy was completed.

Postoperative course was uneventful and the patient is currently undergoing chemotherapy treatment.

Definitive histological findings confirmed high-grade serous carcinoma of 5 cm located in left ovarian and a macrometastasis of 4,5 cm in the paraaortic node. Paraaortic and pelvic lymphadenectomy study were 1/10 and 0/18 respectively.

Uterus, right adnexa and omentum were negative for malignancy. FIGO Stage: IIIA.

Conclusion

• Carefully review of preoperative imaging studies before the surgery is a mandatory step.

• Extraperitoneal laparoscopic approach is a feasible technique to remove paraaortic bulky nodes.

Disclosure Nothing to disclose