Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer

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

“…Moreover, the rate is in line with other studies involving PALND, which have reported corresponding complication rates of 14% to 36%. 14,15,18,24 In conclusion, a transperitoneal high PALND using the SD technique succeeds in more than 80% of the operations. The conversion rate is very low or 2.5%, and the complication rate is satisfactory, with no Clavien-Dindo grade IV or V complications.…”

“…In the previous larger studies using the same SD technique and transperitoneal approach, the median or mean numbers of para-aortic and pelvic nodes have varied between 10 and 15, and 18 and 23, respectively. 14,15 In smaller studies, fewer nodes have been harvested, indicating that a learning curve had probably not yet been established. 12,13 A transperitoneal PALND can also be performed using the double-docking technique.…”

The role of robotic aortic lymphadenectomy in gynecological cancer: surgical and oncological outcome in a single institution experience

“…We chose to adopt the transperitoneal approach because it likely resembles the laparotomic approach: it provides equal access to the precaval, laterocaval, interaortocaval, and preaortic lymph nodes, but given the presence of the inferior mesenteric artery and mesosigmoid vessels, which could result in a difficult removal of the supramesenteric and inframesenteric lymph nodes, especially in obese patients, as described by Seamon et al Additional disadvantages related to high BMI include: the need to move the small bowel away from the surgical field, which requires a high degree of Trendelenburg position that may not be tolerated by some patients; and the limitation of robotic transperitoneal AL to patients with BMI < 35 kg/m 2 has been recommended . However, based on the results reported by James et al, the use of a cut‐off BMI value would exclude some patients from the advantages of successful infrarenal transperitoneal aortic lymphadenectomy. In recognition of this, other factors should be considered beyond the BMI value, including patient habitus, preoperative suspicion of lymph node disease, and type of planned surgical procedures.…”

Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations

“…Approximately half of patients with positive lymph nodes have disease in both pelvic and para-aortic regions [89, 90]. If clinicians prefer to treat node-positive patients with adjuvant radiation therapy, the uncertainty of paraaortic node status in patients who only receive pelvic SLN biopsies can render decisions about the extent of radiation fields difficult.…”