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This video shows a complete left lateral laparoscopic surgical approach for the treatment of endometrial carcinoma in a patient with major pelvic adhesions due to previous surgeries.
In a French university tertiary care hospital, a 73-year-old patient presented with post-menopausal bleeding and was later diagnosed with a grade 3 serous endometrial carcinoma with suspected uterine serosa, cervix, and iliac and latero-aortic lymph node involvement. It was decided to perform a total laparoscopic hysterectomy, bilateral adnexectomy, and pelvic and lumbo-aortic lymphadenectomy.
Previous abdominal interventions, including colon resection because of a volvulus and the placement of two abdominal wall meshes for a midline hernia and a left Spiegel hernia, considerably augmented the risk of adhesions. For that reason, a retroperitoneal approach was considered.
A total left lateral laparoscopic approach, with placement of all four trocars on the left side of the abdomen (Figure 1), and total hysterectomy with bilateral adnexectomy, bilateral pelvic and lumbo-aortic lymphadenectomy until the level of the left renal artery were carried out, always maintaining the left retroperitoneal approach (Online Supplemental File 1).
Supplemental material
Image showing the placement of all four trocars on the left side of the abdomen.
Laparoscopy is possible for the treatment of endometrial carcinoma, even in the presence of major pelvic adhesions due to multiple previous abdominal surgeries.1 A retroperitoneal approach, classically used for lumbo-artic lymph node dissection, can also enable pelvic lymph node dissection and total hysterectomy.2
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All data relevant to the study are included in the article or uploaded as supplementary information.
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This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors NB was responsible for the recruitement of the patient and the conception and design of the study. CCV was responsible for data collection. All authors contributed to the data analysis and interpretation and manuscript preparation. Final approval of the study was made by NB.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.