• cervical cancer
• surgical procedures, operative
• laparoscopes
• gynecologic surgical procedures
• adenocarcinoma

Transposition of the inferior vena cava (IVC), also known as left-sided IVC (LS-IVC), is a rare congenital variant which results from regression of the right supracardinal vein and persistence of the left supracardinal vein in embryonic development.1 2 LS-IVC occurs in 0.2–0.5% of the general population.3 The diagnosis of LS-IVC is a crucial step in performing surgical procedures around the vena cava due to a substantial risk of vascular injury in cases with the relevant anatomical variation. Imaging evaluation is essential to identify vascular anomalies and detect the border of dissection.

A 29-year-old patient was diagnosed with squamous cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) stage IB3). Imaging showed no suspicious pelvic and para-aortic lymphadenopathies but clear evidence of transposition of the IVC. A staging laparoscopic trans-peritoneal aortic lymphadenectomy was performed.

No intra-operative complications were observed. Estimated blood loss was 50 mL, operative time was 90 min, and the hospital stay was 3 days. Histology confirmed negative aortic lymph nodes (N 0/14).

Laparoscopic aortic lymphadenectomy is a complex and challenging surgical procedure that requires wide knowledge of retroperitoneal anatomy, advanced surgical skills, and experience.3 Although the technique has been widely standardized, anatomical anomalies could be fatal. Pre-operative imaging is crucial to identify possible vascular anomalies, and surgeons should always directly visualize imaging in order to reduce the risk of undiagnosed anatomical abnormalities.4

Surgical dissection of para-aortic anatomical spaces in cases with transposition of the IVC can be performed safely, but great caution is required to reduce the risk of fatal adverse events (Video 1).