2022-VA-942-ESGO Laparoscopic extraperitoneal paraaortic and pelvic lymphadenectomy in obese endometrial cancer patients; overview of steps

Introduction/BackgroundObjective describe the extraperitoneal approach to perform complete para-aortic and pelvic lymphadenectomy in patients with endometrial cancers. Theoretically, extraperitoneal approach is technically easier in the obese patient as it naturally creates a bowel-free operative field.MethodologyDescriptive study evaluating laparoscopic extraperitoneal lymphadenectomy in patients with endometrial cancer, 20 patients were enrolled.steps:1.port placement: standard exploration was done. Then, a 1–2 cm incision is made 2–3 cm above and medial to the left anterior superior iliac spine to develop the extraperitoneal space. Another 10–12 mm trocar is placed in mid axillary line and a 5 mm trocar at the subcostal area in the external clavicular line. 2. landmarks: LT psoas major muscle, ureter and gonadal vessels, IMA and left renal vein. 3. Nodal dissection: from level of the bifurcation of Aorta up to left renal vein. 4. LT Pelvic dissection: of LT external iliac artery. The internal iliac artery and its branches. The external iliac vessels should be freed from its pelvic wall. left obturator nerve identification and obturator lymph nodes removal. 5.Right iliac dissection: mesorectum retracted caudally. development of retro-rectal space is important.Results2 cases were shifted to open and excluded from the trial. The median BMI of the patients was (37.5), in 3 (16.6%) cases, right nodal dissection was performed through the transperitoneal approach. The average number of pelvic nodal yield was (20). The mean total operative time was 298 (±53.2) minutes. The mean lymphadenectomy time 194.4 (±34.3) minutes. The mean blood loss was 120 (±25.2) ml. the mean hospital stays1.67 (±0.76) days. No patient experienced tumor recurrence with mean follow-up of 12 (±5.6) months.ConclusionLaparoscopic extraperitoneal pelvic lymphadenectomy is feasible, effective, and safe approach and has an added value when offered to obese females such as cases with endometrial cancer.