Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes

Mäenpää, Minna; Nieminen, Kari; Tomás, Eija; Luukkaala, Tiina; Mäenpää, Johanna

doi:10.1097/igc.0000000000001249

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…On the other hand, another study showed 47% positive pelvic nodes with positive paraaortic lymph nodes and 31% of patients with positive lymphovascular space invasion (LVSI) and metastasis to paraaortic lymph nodes. In patients with positive paraaortic lymph nodes and LVSI, 0.8% of cases were free of metastasis [6,28]. In our study, we did not have cases with metastases to paraaortic lymph nodes.…”

Section: Discussioncontrasting

confidence: 44%

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Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Bizoń,

Olszewski,

Grabowska

et al. 2024

JPM

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(1) The surgical method of choice for the treatment of endometrial cancer is minimally invasive surgery. In cases of high-risk endometrial cancer, completed paraaortic and pelvic lymphadenectomy are indicated. The aim of this study was to analyze the types of docking during robotic surgery assisted with the da Vinci X system while performing paraaortic and pelvic lymphadenectomy. (2) Methods: A total of 25 patients with high-risk endometrial cancer, with a mean age of 60.07 ± 10.67 (range 34.69–83.23) years, and with a mean body mass index (BMI) of 28.4 ± 5.62 (range 18–41.5) kg/m2, were included in this study. The analyzed population was divided into groups that underwent single or dual docking during surgery. (3) Results: No statistical significance was observed between single and dual docking during paraaortic and pelvic lymphadenectomy and between the type of docking and the duration of the operation. However, there was a statistically significant correlation between the duration of the operation and previous surgery (p < 0.005). The number of removed lymph nodes was statistically associated with BMI (p < 0.005): 15.87 ± 6.83 and 24.5 ± 8.7 for paraaortic and pelvic lymph nodes, respectively, in cases of single docking, and 18.05 ± 7.92 and 24.88 ± 11.75 for paraaortic and pelvic lymph nodes, respectively, in cases of dual docking. (4) Conclusions: The robot-assisted approach is a good surgical method for lymphadenectomy for obese patients, and, despite the type of docking, there are no differences in the quality of surgery.

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Section: Discussioncontrasting

confidence: 44%

“…In 14 cases, the uterus was removed by mini laparotomy because of a narrow vagina or a large uterus. BMI of 35 kg/m 2 was the limit of successful lymphadenectomy; in cases with a BMI higher than 35, the complication rate was increased [28]. In our investigation, a few cases with BMI above 35 kg/m 2 were included.…”

Section: Discussionmentioning

confidence: 93%

Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Bizoń,

Olszewski,

Grabowska

et al. 2024

JPM

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“…A surgical advancement process called "minimally invasive surgery" has enabled minimizing the visibility of the infected area. The da Vinci Surgical System is a surgical robotics with a virtual 3D actuality visual acuity system that provides a greater profile in laparoscopic surgery where health professionals cannot physiologically see the affected area [ 24 ]. In 2000, the Food and Drug Administration approved the technology for clinical use [ 25 ].…”

Section: Reviewmentioning

confidence: 99%

Robot-Assisted Surgery in the Treatment of Gynecological Carcinoma and Malignancies: Introduction to the da Vinci Robotic Surgery System

Goel,

Pamnani,

Anjankar

2023

Cureus

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Robotic surgery is a surgical intervention that was developed from traditional manual surgeries because of the intrusive procedures it uses. It is now accomplished in hospitals worldwide, and comprehensive programs for the application of technology in the management of gynecological cancer are being developed. Robotic surgery should be straightforwardly compared with manual and traditional laparoscopy to see if the higher indirect costs are justified by some improvements in patient studies. This paper aims to evaluate the procedure of robotic surgery and its implementation in gynecological cancer to verify its safeness, practicability, and effectiveness. A higher chance of infections is usually in classical surgery, particularly in comparison to laparoscopic or robotic surgery. Surgical and hospital stay are much less with any of these new technologies than the aforementioned; however, the drawbacks are the scarcity of robot systems, their high price, and the realization that it is only appropriate in learning institutions with infrastructure and highly skilled surgeons. In conclusion, tissue engineering constitutes a significant discovery and approach for treating gynecological cancer with improved methods than some other types of traditional surgery, and it will likely become dominant technology shortly.

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Improvements and challenges in intraperitoneal laparoscopic para‐aortic lymphadenectomy: The novel “tent‐pitching” antegrade approach and vascular anatomical variations in the para‐aortic region

Chai,

Zhu,

Chen

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionThis study introduces and compares a new intraperitoneal laparoscopic para‐aortic lymphadenectomy method to reach the level of the renal vein, the “tent‐pitching” antegrade approach with the retrograde approach in gynecological malignancy surgeries in terms of success rate, complication incidence, and the number of lymph nodes removed. It focuses on the feasibility, safety, and effectiveness. Meanwhile, this article reports on the vascular anatomical variations discovered in the para‐aortic region to enhance surgical safety.Material and MethodsThis was a retrospective cohort study including patients undergone laparoscopic para‐aortic lymphadenectomy at a single center from January 2020 to December 2023 for high‐risk endometrial and early‐stage ovarian cancer. Patient charts were reviewed for mode of operation, perioperative complications, operative details, and histopathology. The patients were divided into anterograde group and retrograde group according to the operation mode. The two groups were further compared based on the success rate of lymph node clearance at the renal vein level, perioperative complications, and the number of removed lymph nodes. Quantitative data were analyzed using the t‐test, non‐normally distributed data using the rank‐sum test, and categorical data using Fisher's exact test and the chi‐square test, with statistical significance defined as P < 0.05.ResultsAmong 173 patients, the antegrade group showed higher surgery success (97.5% vs 68.82%), more lymph nodes removed (median 14 vs 7), and less median blood loss. The operation time was shorter in the antegrade group. Postoperative complications like lymphocele and venous thrombosis were lower in the antegrade group. Vascular abnormalities were found in 28.9% of patients, with accessory lumbar vein routing anomaly and accessory renal arteries being most common.ConclusionsThe antegrade approach is feasible, safe, and effective, improving surgical exposure, reducing difficulty without additional instruments or puncture sites, and minimizing organ damage risk. It is effective in achieving better access to the renal vein and removing more para‐aortic lymph nodes than the retrograde method. Recognizing and carefully managing the diverse vascular abnormalities in the para‐aortic area, including variations in renal arteries, veins, and the inferior vena cava, is essential to reduce intraoperative bleeding and the likelihood of converting to open surgery.

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Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes

Abstract: Using the transperitoneal technique for PALND, the area between IMA and the renal veins can be reached in more than 80% of the operations, with a very low or 2.5% conversion rate.

Cited by 6 publications

References 24 publications

Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Robot-Assisted Surgery in the Treatment of Gynecological Carcinoma and Malignancies: Introduction to the da Vinci Robotic Surgery System

Improvements and challenges in intraperitoneal laparoscopic para‐aortic lymphadenectomy: The novel “tent‐pitching” antegrade approach and vascular anatomical variations in the para‐aortic region

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