Introduction/Background Potential vascular risks should be taken into account during extra-peritoneal para-aortic laparoscopic lymphadenectomy

Methodology CLINICAL CASE 47 yo postmenopausal woman with subclinical hypotyroidism and 2 previous vaginal deliveries affected of an endometrial endometrioid carcinoma grade 1, FIGO 1A stage on US, RMI and CT scan. BMI 25,7.

First surgery: laparoscopic hysterectomy, double adnexectomy and pelvic lymphadenectomy.

Pathologic report: endometrial endometrioid poorly differentiated carcinoma, with myometrial involvement <50%, FIGO 1A, without lymphatic or vascular involvement.

Second surgery: laparoscopic paraortic infrarenal lymphadenectomy.

Pathologic report: absence of nodal involvement

IN THIS VIDEO After removing the lymphatic tissue, an unexpected sectioned artery appears antero-laterally to the aorta towards the kidney, this is the renal artery appearing more caudal tan expected.

Results Vascular anomalies appear in 13.6% of patients with cervical, endometrial, and ovarian cancer treated with systematic aortic and pelvic lymphadenectomy.

Retro-aortic left renal vein, double vena cava or left vena cava are the most frequent vascular anomalies detected preoperatively. Other vascular anomalies are less frequent and are not reported by the radiologist.

It is described a 0,06% of unidentified abnormal vessel injury. Distorted anatomy is described in 63% of patients with hemorrhagic complications due to vascular injuries.

Vascular repairs during gynecologic operations are rare (0,09%), and are associated with morbidity and mortality.

Anatomical abnormalities of renal vessels are difficult to diagnose preoperatively. Several anatomical variations of the renal arteries, with an aortic lower polar artery found in 3% of cadavers and 1% of patients on CT, more frequently on the right side.

Accessory polar renal arteries (APRA), are frequently not identified pre-operatively and are infrequently found during Laparoscopic Para-Aortic lymphadenectomy.

Renovascular hypertension secondary to an injury of an APRA has also been described.

Conclusion It is vitally important that the surgeon checks for vascular anomalies pre-operatively, to decrease the risk of complications.

Disclosures Radiologic preoperative review is mandatory.