Introduction/Background Minimally invasive paraaortic lymphadenectomy can be performed using two different approaches: transperitoneal and extraperitoneal. The transperitoneal route offers difficulties with the mobilization and retraction of small bowel and sigmoid colon, worsening the exposure of the surgical field. On the contrary, the extraperitoneal approach provides an excellent anatomical exposure, even in patients with obesity, reducing considerably the adhesion rate, as well as intraoperative complications. It also provides a greater number of nodes retrieval. Preserving the integrity of the peritoneum is essential to achieve extraperitoneal pneumoperitoneum. However, the peritoneum could be damaged occasionally, losing the advantage provided by this approach.

Methodology In this video we show two different techniques to repair the peritoneum torn during its dissection in an extraperitoneal paraaortic lymphadenectomy. The first method consists of placing a Foley catheter into the peritoneal defect, so that the opening is collapsed by the balloon preventing the gas leakage. In the second technique, the defect is closed with staples, inserted through a trocar positioned in the right iliac fossa.

Results In both cases, adequate pneumoperitoneum was attained in the extraperitoneal cavity following the closure of the peritoneal defect, allowing the completion of the extraperitoneal paraaortic lymphadenectomy.

Conclusion The peritoneum may unintentionally rupture during its dissection for an extraperitoneal approach. However, this does not always mean that the approach should be abandoned. There are some strategies for achieving its repair so that the surgical intervention can proceed with a suitable surgical field.

Disclosures The authors declare no conflict of interest.