Introduction Systematic pelvic lymph node dissection is a standard procedure conducted in the management of cervical and high-risk endometrial cancers. This requires a precise understanding of anatomical landmarks in addition to surgical approach, with present’s confusion for trainees amidst multiple learning techniques. Trainees must develop economy of movement and maximise lymph node yield whilst avoiding potential complications including injury to nerves and vessels as well as post-operative morbidity.
Description Identify the boundaries - Lateral border - develop retroperitoneal space by division of round ligament laterally, divide peritoneum along the medial border of psoas muscle with identification of genitofemoral nerve toward paracolic gutter - Medial border – obliterated umbilical artery - dissect along lateral border to level of common iliac vessels bifurcation - Inferior border - obturator nerve – identify obturator foramen following pubic bone with nerve seen below - Caudal border – deep circumflex vessels - Cranial border – bifurcation of common iliac vessels - Lymph node en-bloc dissection technique - Orientation from lateral to medial and caudal to cranial - Initiate from lateral and caudal borders and dissect from external iliac vessels - Once below external iliac vein follow pubic bone to identify obturator nerve as it crosses the obturator foramen, acknowledging corona mortis vessel - Collect lymph nodes within anatomical boundaries - Ensure haemostasis.
Conclusion/Implications We present this case as an aide memoire of a basic gynaecological oncology technique. This is an essential surgical skill to develop with knowledge and practice for all subspecialists in training. https://www.dropbox.com/s/b2k20eph9aomb5a/BPLND%20IGCS.mp4?dl=0
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