Introduction With the increased use of minimally invasive techniques for advanced gynecological neoplasms, progressively more challenging lymph nodal debulking are being performed. Our objective is to present a detailed strategy to safely performed pelvic lymphadenectomy in patients with bulky lymph node metastasis.
Method We present a video demonstrating tips and tricks to resect bulky pelvic lymph nodes using laparoscopy.
Results Pelvic spaces dissection is the first step to achieve surgical field control during pelvic lymphadenectomy, specially in patients with bulky metastasis. After that, proximal and distal dissection of any vessels close to bulky lymph nodes is mandatory if there is risk of bleeding. Dissection of such nodes starts in the heathy tissue and not direct ate the any area adorned to major vessels. A combination of blunt and sharp dissection usually allows resection of most bulky lymph nodes without vascular resection. Some nerves may be dissected and preserved as well. In selected cases, harmonic energy may be useful.
Conclusion Laparoscopic resection pelvic bulky lymph nodes is feasible, but can be demanding and requires different strategies in order to be safe and effective.
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