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Stepwise demonstration of laparoscopic excision of enlarged lymph nodes at the level of the right iliac vessels
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  1. Jun Li1,2,
  2. Ruonan Mao1,2,
  3. Jie Duan1,2 and
  4. Wei Jiang1,2
  1. 1 Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
  2. 2 Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
  1. Correspondence to Dr Wei Jiang, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, Shanghai, China; jiangwei_fckyy{at}163.com

https://doi.org/10.1136/ijgc-2022-003732

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    Summary

    Our aim was to provide a stepwise demonstration of laparoscopic excision of enlarged lymph nodes at the level of the iliac vessels. A 31-year-old woman visited the clinic because of abnormal uterine bleeding. Endometrial curettage revealed a mixed clear cell and endometrioid adenocarcinoma. Preoperative magnetic resonance imaging indicated superficially invasive lesions and no extrauterine involvement was detected. Her serum cancer antigen 125 level was 52.68 U/mL. Total hysterectomy, bilateral salpingo-oophorectomy, and surgical staging by laparoscopy were scheduled. During the procedure, it was found that the lymph nodes at the level of the right iliac vessels were enlarged and dense adhesions were observed between the enlarged nodes and the iliac vessels. Dissection of these lymph nodes is challenging and associated with a high risk of vessel injury, which may lead to severe hemorrhage if performed by inexperienced surgeons. Thus we highlighted the key anatomic structures surrounding the enlarged lymph nodes and summarized the procedure in six reproducible steps (Online Supplemental File 1): (1) opening of the retroperitoneum and development of the pelvic spaces; (2) dissection and medicalization of the ureter; (3) lysis of the adhesions between the enlarged lymph nodes and the internal iliac artery; (4) identification of the obturator nerve and the internal iliac vein; (5) lysis of the adhesions between the enlarged lymph nodes and the external iliac vein; and (6) mobilization of the cranial end of the enlarged lymph nodes. Finally, we resected the enlarged lymph nodes safely. The final pathological reports confirmed metastasis of the pelvic lymph nodes. The patient received six courses of carboplatin/paclitaxel combination therapy after surgery. She is still in complete remission 11 months after surgery. In summary, laparoscopic excision of enlarged lymph nodes at the level of the right iliac vessels was achieved safely with exposure of key anatomic structures surrounding the target lesions.1

    Supplemental material

    Figure 1
    Figure 1

    Enlarged lymph nodes at the level of the right iliac vessels.

    Video 1 Stepwise demonstration of laparoscopic excision of enlarged lymph nodes at the level of the right iliac vessels.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study involves human participants and was approved by the institutional review board of the Obstetrics and Gynecology Hospital of Fudan University (No 2022-13; date, 2022-01-24). Participants gave informed consent to participate in the study before taking part.

    Reference

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      . Pelvic lymphadenectomy in cervical cancer--surgical anatomy and proposal for a new classification system. Gynecol Oncol 2010;116:33–7.doi:10.1016/j.ygyno.2009.09.003 pmid:http://www.ncbi.nlm.nih.gov/pubmed/19837449
      OpenUrlPubMed

    Supplementary materials

    • Supplementary Data

      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

    • JL and RM contributed equally.

    • Contributors Conception and design of the study: JL and WJ. Data collection: all authors. Data analysis and interpretation: JL, RM, and WJ. Responsible surgeon or imager: WJ. Statistical analysis: JL and WJ. Manuscript preparation: JL, RM, and WJ. Patient recruitment: all authors. WJ is responsible for the overall content as the guarantor

    • 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.