Article Text
Abstract
Introduction We developed a series of techniques with novel anatomic concept, which enables para-aortic lymphadenectomy to the left renal vein (LRV) via single-site laparoscopy.
Description The challenge in laparoscopic para-aortic lymphadenectomy largely comes from the lack of stable exposure, which is further aggravated in single-site laparoscopy. The key point of our techniques is to create a stable operating space, which enables single-site laparoscopic para-aortic lymphadenectomy (SSLPAL) to the LRV. The bed was tilted 30 degrees to the right, and 15 degrees towards the head. A folded gauze pad was stuffed into the abdomen through the port, then unfolded to encase the bowels. With gravity, all small intestine were turned to the upper right abdomen. Then, the inferior mesenteric vein and ascending part of duodenum formed an angle, which we named as renal vein angle. The angle apex indicates the location of LRV. This anatomic relationship is very stable and can be utilized for locating LRV before para-aortic lymphadenectomy. Suspending peritoneum on two sides of the angle will create a space without intestine interference, just as it is beneath the embrace of angel wings. We successfully performed SSLPAL to the LRV in 28 patients with gynecological cancers (BMI between 18.1 and 37.3). There was no complication, conversion to laparotomy, or need for adding trocar. The median number of nodes removed was 25 (16 to 37). The details of techniques are still being refined.
Conclusion/Implications Our techniques provide a safe and reliable approach for SSLPAL to the LRV, and may be reproducible for other surgeons.