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  • A new, less invasive approach for retroperitoneal pelvic and para-aortic lymphadenectomy combining the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique and single-port laparoscopy

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A new, less invasive approach for retroperitoneal pelvic and para-aortic lymphadenectomy combining the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique and single-port laparoscopy
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  1. Behzat Can1,
  2. Sedat Akgöl1,
  3. Özgür Adıgüzel1 and
  4. Cihan Kaya2
    1. 1 Gynecological Oncology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
    2. 2 Obstetrics and Gynecolgy, Acıbadem Health Care Group, Acıbadem Bakirköy Hospital, Istanbul, Turkey
    1. Correspondence to Dr Behzat Can, Gynecological Oncology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey; drbehzatcan{at}gmail.com

    https://doi.org/10.1136/ijgc-2023-005093

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      Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a safe and feasible technique. It broadens the indications of conventional vaginal surgery.1

      Recently, a new retroperitoneal sentinel lymph node biopsy via the vNOTES approach was defined for endometrial cancer patients.2

      Extraperitoneal laparoscopic para-aortic lymphadenectomy has been reported as a feasible technique for endometrial carcinoma and cervical cancer staging.3

      However, the combination of vNOTES with extraperitoneal single-port laparoscopic lymphadenectomy for staging endometrial carcinoma has not been investigated to date.

      In this video we present the surgical management of a 53-year-old female who presented with post-menopausal bleeding. Endometrial sampling revealed an endometrioid-type Grade 3 endometrial carcinoma. Further investigation revealed no metastasis. A pelvic and para-aortic total retroperitoneal lymphadenectomy combining the vNOTES technique and single-port extraperitoneal laparoscopy was performed (Figure 1). Surgery duration was 210 min and mean blood loss was approximately 150 mL. Post-operative visual analog scale (VAS) pain scores were 6 at 6 hours and 1 at 24 hours. The patient was discharged 30 hours after surgery. The final pathology revealed endometrioid-type Grade 3 endometrial cancer, myometrial invasion greater than 50%, and lymphovascular space invasion. Also, 24 pelvic and 21 para-aortic reactive lymph nodes were reported. Post-operative brachytherapy was planned.

      Figure 1
      Figure 1

      Abdominal view of a single-port extraperitoneal laparoscopic para-aortic lymphadenectomy.

      In conclusion, the vNOTES approach provides rapid post-operative recovery and no trocar- or incision-related complications. Besides, the retroperitoneal vNOTES approach provides easy access to pelvic lymph nodes and allows to perform single-port extraperitoneal para-aortic lymphadenectomy by reducing entry-related risks such as peritoneal tears or gas leakage during abdominal port insertion.

      This video demonstrates when indicated combination of vNOTES and single-port laparoscopy could be feasible for performing bilateral pelvic and para-aortic lymphadenectomy in high-grade endometrial cancer patients.

      Video 1 A new, less invasive approach for retroperitoneal pelvic and para-aortic lymphadenectomy combining the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique and single-port laparoscopy.

      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 but ethics committee exemption was obtained. A consent form was obtained from the patient. Participants gave informed consent to participate in the study before taking part.

      References

      1. ↵
        2. Kaya C ,
        3. Alay İ ,
        4. Ekin M , et al
        . Hysterectomy by vaginal-assisted natural orifice transluminal endoscopic surgery: initial experience with twelve cases. J Turk Ger Gynecol Assoc 2018;19:34–8. doi:10.4274/jtgga.2017.0075
        OpenUrl
      2. ↵
        2. Baekelandt JF
        . New retroperitoneal transvaginal natural orifice transluminal endoscopic surgery approach to sentinel node for endometrial cancer: a demonstration video. J Minim Invasive Gynecol 2019;26:1231–2. doi:10.1016/j.jmig.2019.05.002
        OpenUrlCrossRefPubMed
      3. ↵
        2. Zhang W ,
        3. Xia L ,
        4. Han X , et al
        . Extraperitoneal laparoscopy for para-aortic lymphadenectomy in endometrial carcinoma staging: an approach with higher efficiency. World J Surg Oncol 2021;19:323. doi:10.1186/s12957-021-02416-x
        OpenUrl

      Footnotes

      • X @drcihankaya@hotmail.com

      • Contributors BC: data collection, writing, critical review, guarantor. SA: data collection, critical review. OA: data collection, critical review. CK: writing, critical review.

      • 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.