Surgical Endoscopy

, Volume 26, Issue 9, pp 2430–2435

Robotically assisted laparoscopy for paraaortic lymphadenectomy: technical description and results of an initial experience

  • Eric Lambaudie
  • Fabrice Narducci
  • Eric Leblanc
  • Marie Bannier
  • Camille Jauffret
  • Francesco Cannone
  • Gilles Houvenaeghel
Article

Abstract

Objective

The objective of this study is to demonstrate the feasibility of robotically assisted laparoscopy paraaortic lymphadenectomy (PAL), isolated or combined with another procedure using different surgical approaches.

Methods

From February 2007 to December 2010, 53 patients underwent paraaortic lymphadenectomy up to the left renal vein. We used three different approaches with three different positions for the robot in relation to the surgical procedure (isolated transperitoneal PAL, isolated extraperitoneal PAL, or transperitoneal PAL combined with another procedure). Thirty-nine patients underwent isolated lomboaortic lymphadenectomy and 14 a combined procedure. Information concerning installation time, operative time, peri- and postoperative complications, blood loss, lymph node count, and conversion rate was recorded.

Results

For the whole population, mean installation time was 33 ± 18 min, mean operative time was 197 ± 81 min, and mean hospital stay was 3.9 ± 2.8 days. We observed 15.1% lymph node involvement at definitive pathology. Between isolated trans- and extraperitoneal PAL, only body mass index (BMI, 27.4 versus 22 kg/m2) was significantly different. No difference was observed concerning mean number of lymph nodes or hospital stay. We observed statistical difference between combined and isolated PAL concerning mean operative time (256 versus 160 min), mean number of lymph nodes (7.8 versus 14.6), and hospital stay (5.9 versus 2.9 days).

Conclusions

Although laparoscopic robotic-assisted PAL is a safe and feasible procedure, lymph node staging seems to be better if the procedure is isolated. In case of combined procedures, the surgical approach should be modified regarding patient BMI and the associated procedure, to increase lymph node count.

Keywords

Robotic surgery Paraaortic lymphadenectomy 

References

  1. 1.
    Magrina JF, Long JB, Kho RM, Giles DL, Montero RP, Magtibay PM (2010) Robotic transperitoneal infrarenal aortic lymphadenectomy: technique and results. Int J Gynecol Cancer 20:184–187PubMedCrossRefGoogle Scholar
  2. 2.
    Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr (2002) Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc 16:1271–1273PubMedCrossRefGoogle Scholar
  3. 3.
    Narducci F, Lambaudie E, Houvenaeghel G, Collinet P, Leblanc E (2009) Early experience of robotic-assisted laparoscopy for extraperitoneal para-aortic lymphadenectomy up to the left renal vein. Gynecol Oncol 115(1):172–174PubMedCrossRefGoogle Scholar
  4. 4.
    Lambaudie E, Houvenaeghel G, Walz J, Bannier M, Buttarelli M, Gurriet B, De Laparrent T, Blache JL (2008) Robot-assisted laparoscopy in gynecologic oncology. Surg Endosc 22(12):2743–2747PubMedCrossRefGoogle Scholar
  5. 5.
    Leblanc E, Narducci F, Frumovitz M, Lesoin A, Castelain B, Baranzelli MC, Taieb S, Fournier C, Querleu D (2007) Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol 105:30411CrossRefGoogle Scholar
  6. 6.
    Leblanc E, Caty A, Dargent D, Querleu D, Mazeman E (2001) Extraperitoneal laparoscopic para-aortic lymph node dissection for early stage non seminomatous germ cell tumors of the testis with introduction of a nerve sparing technique: description and results. J Urol 165:89–92PubMedCrossRefGoogle Scholar
  7. 7.
    Possover M, Krause N, Plaul K, Kuhne-Heid R, Schneider A (1998) Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature. Gynecol Oncol 71:19–28PubMedCrossRefGoogle Scholar
  8. 8.
    Querleu D, Leblanc E, Cartron G, Narducci F, Ferron G, Martel P (2006) Audit of preoperative and early complications of laparoscopic lymph node dissection in 1000 gynecologic cancer patients. Am J Obstet Gynecol 195:1287–1292PubMedCrossRefGoogle Scholar
  9. 9.
    Holloway RW, Ahmad S, DeNardis SA, Peterson LB, Sultana N, Bigsby GE IV, Pikaart DP, Finkler NJ (2009) Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol Oncol 115:447–452PubMedCrossRefGoogle Scholar
  10. 10.
    Boggess JF, Gehrig P, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199(4):360e1–360e9Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Eric Lambaudie
    • 1
  • Fabrice Narducci
    • 2
  • Eric Leblanc
    • 2
  • Marie Bannier
    • 1
  • Camille Jauffret
    • 1
  • Francesco Cannone
    • 1
  • Gilles Houvenaeghel
    • 1
  1. 1.Department of SurgeryPaoli Calmettes InstituteMarseilleFrance
  2. 2.Department of SurgeryOscar Lambret CenterLille cedexFrance

Personalised recommendations