Introduction/Background Laparoscopic para-aortic lymph node dissection can be performed through the extraperitoneal or transperitoneal approach. Retroperitoneal para-aortic lymphadenectomy was described by Dargent in 2000. Recent evidence has demonstrated that the extraperitoneal approach is associated with a higher number of lymph nodes removed with similar surgical outcomes as the transperitoneal route. Therefore, a surgical video focused on the anatomy of para-aortic retroperitoneal spaces and the surgical technique of extraperitoneal para-aortic lymphadenectomy is presented.

Methodology A 46-year-old woman presented with endometrial adenocarcinoma G2, myometrial invasion >50%, and enlarged para-aortic lymph nodes up to the level of the renal veins on MRI. Surgery is the treatment of choice for the uterine malignancies. The surgery started with performing a laparoscopic extraperitoneal para-aortic lymphadenectomy, followed by hysterectomy with bilateral salpingo-oophorectomy and transperitoneal pelvic lymphadenectomy was planned. No evidence of extra-uterine macroscopic disease was noted during surgery.

Results The surgical specimen confirmed an endometrial carcinosma with myometrial invasion higher than 50%, without serosal invasion. Pelvic lymphadenectomy revealed 11 nodes without neoplastic infiltration. A total of 4 para-aortic nodes removed and had no neoplastic infiltration. The main advantages of extraperitoneal route include a faster access to the lymph nodes area with an adequate exposure of the surgical field. Trendelenburg position is not necessary, thus reducing the patient’s haemodynamic instability during surgery.

Conclusion The extraperitoneal approach may be a feasible, safe alternative for laparoscopic para-aortic lymphadenectomy. However, an adequate learning curve and an in-depth knowledge of the retroperitoneal anatomy are highly important for this approach.

Disclosures None.