Introduction The purpose of this article is to demonstrate the possibility of single port assisted laparoscopic debulking surgery for endometrial cancer patients with bulky lymph node metastasis.
Description A 36-year-old married woman with abnormal vaginal bleeding was diagnosed with grade 3 endometrioid endometrial cancer. Pelvic and abdominal MRI revealed endometrial lesions invading more than half of the myometrium. In addition, multiple enlarged lymph nodes suggestive of metastasis were shown in both iliac chains, paraaortic, and retroperitoneal area. The largest paraaortic lymph node is about 4 cm in size. The patient underwent a single-port approach laparoscopic debulking. After indocyanine green injection into the cervix, we performed pelvic and paraaortic lymph node dissection. The largest lymph node, about 40 mm, is noted on the L3L, severely adhered to vessels and soft tissues. Single-port approach laparoscopic debulking including hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic and paraaortic lymph node dissection and pelvic peritonectomy was done. We achieved complete resection without complications. The total operating time was 7 hours. According to the final pathological reports, the patient was diagnosed with endometrial cancer stage IVB. 12 of 29 lymph nodes were contained with metastasis, and extrapelvic peritoneal metastasis was noted. The patient was discharged on the 3rd postoperative day without any surgical complications such as lymphocele and treated with systemic chemotherapy after the operation. There was no recurrence or complications. The progression-free interval was 14 months.
Conclusion/Implications Single port assisted laparoscopic debulking operation is feasible for endometrial cancer with bulky lymph node lesions.
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