Objectives: To report the first clinical experience with laparoendoscopic single-site (LESS) extraperitoneal aortic lymphadenectomy.
Materials and methods: A 33-year-old woman with biopsy proven locally advanced squamous cell carcinoma of the cervix was taken to the operating room for surgical staging. Preoperative imaging did not detect any aortic lymph node metastases. Informed consent for LESS extraperitoneal aortic lymphadenectomy was obtained. A 2 cm transverse incision was made on the left side midway between the iliac crest and inferior costal margin along the middle axillary line. The preperitoneal space was created and the Triport(TM) inserted. Using the Deflectable-Tip EndoEye(TM) laparoscope and two straight instruments, the aortic lymphadenectomy was performed as defined by the disease-specific oncologic principles.
Results: The procedure was completed in 125 minutes. There were no intraoperative or postoperative complications, and the blood loss was minimal (10 mL). The patient was discharged home on postoperative day number 1. LESS extraperitoneal aortic lymphadenectomy yielded 10 lymph nodes. Microscopic metastatic squamous cell carcinoma was detected in 1 out of the 10 lymph nodes. Her treatment plan was modified to extend the field of radiation to include the paraaortic lymphatic basins.
Conclusions: LESS extraperitoneal aortic lymphadenectomy is feasible and safe, and provides a comprehensive assessment of aortic lymph nodes as defined by the disease-specific oncologic principles.