Skip to main content
SpringerLink
Log in

Robotic Para-aortic Lymph Node Dissection

  • Chapter
  • First Online:
Textbook of Gynecologic Robotic Surgery

  • 641 Accesses

Abstract

Use of the robotic surgical platform in gynecologic oncology, including para-aortic lymph node dissection, has steadily increased due to improved dexterity, better visualization, increased primary surgeon independence, and increased comfort over conventional laparoscopic equipment. With patient positioning and robotic docking techniques to improve access to the infrarenal para-aortic lymph nodes, robotic para-aortic lymph node dissection may be safely performed without diminishing the number of para-aortic lymph nodes removed. In this chapter, we review the published data on the safety and feasibility of robotic-assisted para-aortic lymphadenectomy in gynecologic oncology as well as describe the procedure itself, including trocar placement, patient positioning, and robot docking.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Visco A, Advincula AP. Robotic gynecologic surgery. Obstet Gynecol. 2008;112:1369–84.

    Article  PubMed  Google Scholar 

  2. Conrad LB, Ramirez PT, Burke W, Naumann RW, Ring KL, Munsell MF, et al. Role of minimally invasive surgery in gynecologic oncology: an updated survey of members of the Society of Gynecologic Oncology. Int J Gynecol Cancer. 2015;25(6):1121–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nick AM, Ramirez PT. The impact of robotic surgery on gynecologic oncology. J Gynecol Oncol. 2011;22(3):196–202.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Eriksson AGZ, Ducie J, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparison of a sentineal lymph node and selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. Gynecol Oncol. 2016;140(3):394–9.

    Article  Google Scholar 

  5. Mario M, Leitao J, Briscoe G, Santos K, Winder A, Jewell EL, Hoskins WJ, et al. Introduction of a computer-based surgical platform in the surgical care of patients with newly diagnosed uterine cancer: outcomes and impact on approach. Gynecol Oncol. 2012;125:394–9.

    Article  Google Scholar 

  6. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008;199:360.e1–9.

    Article  Google Scholar 

  7. Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol. 2010;116(6):1422–31.

    Article  PubMed  Google Scholar 

  8. Brudie LA, Backes FJ, Ahmad S, Zhu X, Finkler NJ, Bigsby GE IV, et al. Analysis of disease recurrence and survival for women with uterine malignancies undergoing robotic surgery. Gynecol Oncol. 2013;128:309–15.

    Article  PubMed  Google Scholar 

  9. Soliman PT, Frumovitz M, Sun CC, dos Reis R, Schmeler KM, Nick AM, et al. Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. Gynecol Oncol. 2011;123:333–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chen C-H, Chiu L-H, Chang C-W, Yen Y-K, Huang Y-H, Liu W-M. Comparing robotic surgery with conventional laparoscopy and laparotomy for cervical cancer management. Int J Gynecol Cancer. 2014;24(6):1105–11.

    Article  PubMed  Google Scholar 

  11. Feuer GA, Lakhi N, Barker J, Salmieri S, Burrell M. Perioperative and clinical outcomes in the management of epithelial ovarian cancer using a robotic or abdominal approach. Gynecol Oncol. 2013;131:520–4.

    Article  PubMed  Google Scholar 

  12. Chen C-H, Chiu L-H, Chen H-H, Chan C, Liu W-M. Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer. Int J Med Robot. 2016;12(2):268–75.

    Article  PubMed  Google Scholar 

  13. Magrina JF, Cetta RL, Chang Y-H, Guevara G, Magtibay PM. Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy. Gynecol Oncol. 2013;129:336–40.

    Article  PubMed  Google Scholar 

  14. Magrina JF, Zanagnolo V, Giles D, Noble BN, Kho RMC, Magtibay PM. Robotic surgery for endometrial cancer: comparison of perioperative outcomes and recurrence with laparoscopy, vaginal/laparoscopy and laparotomy. Eur J Gynaecol Oncol. 2011;32(5):476–80.

    CAS  PubMed  Google Scholar 

  15. Franke O, Narducci F, Chereau-Ewald E, Orsoni M, Jauffret C, Leblanc E, et al. Role of a double docking to improve lymph node dissection: when robotically assisted laparoscopy for para-aortic lymphadenectomy is associated to a pelvic procedure. Int J Gynecol Cancer. 2015;25:331–6.

    Article  PubMed  Google Scholar 

  16. James JA, Rakowski JA, Jeppson CN, Stavitzski NM, Ahmad S, Holloway RW. Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer. Gynecol Oncol. 2015;136:285–92.

    Article  PubMed  Google Scholar 

  17. Magrina JF, Long JB, Kho RM, Giles DL, Montero RP, Magtibay PM. Robotic transperitoneal infrarenal aortic lymphadenectomy: technique and results. Int J Gynecol Cancer. 2010;20:184–7.

    Article  PubMed  Google Scholar 

  18. Ponce J, Barahona M, Pla MJ, Rovira J, Garcia-Tejedor A, Gil-Ibanez B, et al. Robotic transperitoneal infrarenal para-aortic lymphadenectomy with double docking: technique, learning curve, and perioperative outcomes. J Minim Invasive Gynecol. 2016;23:622–7.

    Article  PubMed  Google Scholar 

  19. Zanagnolo V, Rollo D, Tomaselli T, Rosenberg PG, Bocciolone L, Landoni F, et al. Robotic-assisted transperitoneal aortic lymphadenectomy as part of staging procedure for gynaecological malignancies: single institution experience. Obstet Gynecol Int. 2013;2013:931318.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ekdahl L, Salehi S, Falconer H. Improving double docking for robotic-assisted para-aortic lymphadenectomy in endometrial cancer staging: technique and surgical outcomes. J Minim Invasive Gynecol. 2016;23:818–24.

    Article  PubMed  Google Scholar 

  21. Vergote I, Pouseele B, Van Gorp T, Vanacker B, Leunen K, Cadron I, et al. Robotic retroperitoneal lower para-aortic lymphadenectomy in cervical carcinoma: first report on the technique used in 5 patients. Acta Obstet Gynecol. 2008;87:783–7.

    Article  Google Scholar 

  22. Chon HS, Bush WD, Kang CW, Hoffman M. Robotic-assisted resection of isolated paraaortic lymph node recurrence with right lateral decubitus position. J Robot Surg. 2013;7:205–7.

    Article  PubMed  Google Scholar 

  23. Diaz-Feijoo B, Gil-Ibanez B, Perez-Benavente A, Martinez-Gomez X, Colas E, Sanchez-Iglesias JL, et al. Comparison of robotic-assisted vs conventional laparoscopy for extraperitoneal paraaortic lymphadenectomy. Gynecol Oncol. 2014;132:98–101.

    Article  CAS  PubMed  Google Scholar 

  24. Fastrez M, Goffin F, Vergote I, Vandromme J, Petit P, Leunen K, et al. Multi-center experience of robot-assisted laparoscopic para-aortic lymphadenectomy for staging of locally advanced cervical carcinoma. Acta Obstet Gynecol Scand. 2013;92(8):895–901.

    Article  PubMed  Google Scholar 

  25. Fastrez M, Vandromme J, George P, Rozenberg S, Dequeldre M. Robot assisted laparoscopic transperitoneal para-aortic lymphadenectomy in the management of advanced cervical carcinoma. Eur J Obstet Gynecol Reprod Biol. 2009;147(2):226–9.

    Article  PubMed  Google Scholar 

  26. Narducci F, Lambaudie E, Mautone D, Hudry D, Bresson L, Leblanc E. Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy in gynecologic oncology: preliminary experience and advantages and limitations. Int J Gynecol Cancer. 2015;25:1494–502.

    Article  PubMed  Google Scholar 

  27. Narducci F, Lambaudie E, Houvenaeghel G, Collinet P, Leblanc E. Early experience of robotic-assisted laparoscopy for extraperitoneal para-aortic lymphadenectomy up to the left renal vein. Gynecol Oncol. 2009;115:172–4.

    Article  CAS  PubMed  Google Scholar 

  28. Pakish J, Soliman PT, Frumovitz M, Westin SN, Schmeler KM, Dos Reis R, et al. A comparison of extraperitoneal versus transperitoneal laparoscopic or robotic para-aortic lymphadenectomy for staging of endometrial carcinoma. Gynecol Oncol. 2014;132:366–71.

    Article  PubMed  Google Scholar 

  29. Akladios C, Ronzino V, Schrot-Sanyan S, Afors K, Fernandes R, Baldauf JJ, et al. Comparison between transperitoneal and extraperitoneal laparoscopic paraaortic lymphadenectomy in gynecologic malignancies. J Minim Invasive Gynecol. 2015;22:268–74.

    Article  PubMed  Google Scholar 

  30. Huang M, Slomovitz BM, Ramirez PT. Transperitoneal versus extraperitoneal para-aortic lymphadenectomy in patients with cervical cancer. Rev Obstet Gynecol. 2009;2(2):101–6.

    PubMed  PubMed Central  Google Scholar 

  31. Sonoda Y, Akladios CY, Querleu D, Leblanc E. Extraperitoneal lymph node dissection. In: Abu-Rustum NR, Barakat RR, Levine DA, editors. Atlas of procedures in gynecologic oncology. 3rd ed. Boca Raton: CRC/Taylor & Francis Group; 2013. p. 74–82.

    Chapter  Google Scholar 

  32. Sonoda Y, Leblanc E, Querleu D, Castelain B, Papageorgiou TH, Lambaudie E, et al. Prospective evaluation of surgical staging of advanced cervical cancer via a laparoscopic extraperitoneal approach. Gynecol Oncol. 2003;91:326–31.

    Article  CAS  PubMed  Google Scholar 

  33. Leblanc E, Narducci F, Frumovitz M, Lesoin A, Castelain B, Baranzelli MC, et al. Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol. 2007;105:304–11.

    Article  PubMed  Google Scholar 

  34. Higuchi TT, Gettman MT. Robotic instrumentation and operating room setup. In: Hemal AK, Menon M, editors. Robotics in genitourinary surgery. London: Springer; 2011. p. 25–36.

    Chapter  Google Scholar 

  35. Jacob KA, Zanagnolo V, Magrina JF, Magtibay P. Robotic transperitoneal infrarenal aortic lymphadenectomy for gynecologic malignancy: a left lateral approach. J Laparoendosc Adv Surg Tech. 2011;21(8):733–6.

    Article  Google Scholar 

  36. Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol. 2010;17:414–20.

    Article  PubMed  Google Scholar 

  37. Leitao MM Jr, Sonoda Y. Laparoscopic and robotic staging procedures for gynecologic malignancies. In: Abu-Rustum NR, Barakat RR, Levine DA, editors. Atlas of procedures in gynecologic oncology. 3rd ed. Boca Raton: CRC/Taylor & Francis Group; 2013. p. 44–53.

    Google Scholar 

  38. Seamon LG, Cohn DE, Henretta MS, Kim KH, Carlson MJ, Phillips GS, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol. 2009;113:36–41.

    Article  PubMed  Google Scholar 

  39. Cardenas-Goicoechea J, Adams S, Bhat SB, Randall TC. Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol. 2010;117(2):224–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Cardenas-Goicoechea J, Shepherd A, Momeni M, Mandeli J, Chuang L, Gretz H, et al. Survival analysis of robotic versus traditional laparoscopic surgical staging for endometrial cancer. Am J Obstet Gynecol. 2014;210:160.e1–e11.

    Article  Google Scholar 

  41. Soto E, Soto C, Nezhat FR, Gretz HF, Chuang L. Chylous ascites following robotic lymph node dissection on a patient with metastatic cervical carcinoma. J Gynecol Oncol. 2011;22(1):61–3.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hudry D, Ahmad S, Zanagnolo V, Narducci F, Fastrez M, Ponce J, et al. Robotically assisted para-aortic lymphadenectomy: surgical results, a cohort study of 487 patients. Int J Gynecol Cancer. 2015;25:504–11.

    Article  PubMed  Google Scholar 

  43. Coronado PJ, Fasero M, Magrina JF, Herraiz MA, Vidart JA. Comparison of perioperative outcomes and cost between robotic-assisted and conventional laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL). J Minim Invasive Gynecol. 2014;21:674–81.

    Article  PubMed  Google Scholar 

  44. Querleu D, Leblanc E, Cartron G, Narducci F, Ferron G, Martel P. Audit of preoperative and early complications of laparoscopic lymph node dissection in 1000 gynecologic cancer patients. Am J Obstet Gynecol. 2006;195:1287–92.

    Article  PubMed  Google Scholar 

  45. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2. J Clin Oncol. 2009;27(32):5331–6.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Perutelli A, Garibaldi S, Gargini A, Baldacci C, Basile S, Salerno MG. Robotic management of major vessel injury during pelvic lymphadenectomy. J Minim Invasive Gynecol. 2013;20:115–8.

    Article  PubMed  Google Scholar 

  47. Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW. Recognition and management of major vessel injury during laparoscopy. J Minim Invasive Gynecol. 2010;17:692–702.

    Article  PubMed  Google Scholar 

  48. Lee Z, Kaplan J, Giusto L, Eun D. Prevention of iatrogenic ureteral injuries during robotic gynecologic surgery: a review. Am J Obstet Gynecol. 2016;214(5):566–71.

    Article  PubMed  Google Scholar 

  49. Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014;6(3):115–24.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Weinberger V, Cibula D, Zikan M. Lymphocele: prevalence and management in gynecological malignancies. Exp Rev Anticancer Ther. 2014;14(3):307–17.

    Article  CAS  Google Scholar 

  51. Ditto A, Martinelli F, Reato C, Kusamura S, Solima E, Fontanelli R, et al. Systematic para-aortic and pelvic lymphadenectomy in early stage epithelial ovarian cancer: a prospective study. Ann Surg Oncol. 2012;19:3849–55.

    Article  PubMed  Google Scholar 

  52. Konno Y, Todo Y, Minobe S, Kato H, Okamoto K, Sudo S, et al. A restrospective analysis of postoperative complications with or without para-aortic lymphadenectomy in endometrial cancer. Int J Gynecol Cancer. 2011;21(2):385–90.

    Article  PubMed  Google Scholar 

  53. ASTEC study group. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:126–36.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Brooke A. Schlappe M.D. & Mario M. Leitao Jr M.D.

Authors
  1. Brooke A. Schlappe M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario M. Leitao Jr M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mario M. Leitao Jr M.D. .

Editor information

Editors and Affiliations

  1. Department of Gynaecological Oncology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, United Kingdom

    Alaa El-Ghobashy

  2. Department of Gynaecological Oncology, Royal Marsden and St George’s Hospitals, London, United Kingdom

    Thomas Ind

  3. Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden

    Jan Persson

  4. Department of Gynecological Oncology, Mayo Clinic, Phoenix, Arizona, USA

    Javier F. Magrina

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Schlappe, B.A., Leitao, M.M. (2018). Robotic Para-aortic Lymph Node Dissection. In: El-Ghobashy, A., Ind, T., Persson, J., Magrina, J. (eds) Textbook of Gynecologic Robotic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-63429-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63429-6_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63428-9

  • Online ISBN: 978-3-319-63429-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation