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Laparoscopic ultrasound-assisted liposuction for lymph node dissection: a pilot study

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Abstract

Background

Lymphadenectomy is a surgical technique for staging and treating cancer. Laparoscopic lymphadenectomy for obese patients is challenging. Laparoscopic ultrasound-assisted liposuction (UAL) has been successful in porcine models. The current study aimed to evaluate whether UAL facilitates pelvic laparoscopic lymphadenectomy in obese subjects.

Methods

The UAL technique was evaluated in two human cadavers and in six obese Ossabaw pigs. Both a standard and a prototype ultrasonic probe with a wider contact surface were tested. Pelvic lymphadenectomy comparing UAL with standard monopolar cautery was performed using obese Ossabaw pigs. The animals were survived for 2 weeks. Descriptive data regarding intra- and postoperative outcomes were recorded, including histologic analysis of dissected tissue after 2 weeks. Cytologic analysis of aspirated fluid coming from UAL also was recorded.

Results

The UAL procedure was safely performed for all the cadavers and animals. Lymph node exposure and clean exposure of surrounding structures were dramatic compared with monopolar assisted dissection. One animal was excluded from further analysis due to ultrasonic device malfunction (a broken footswitch cord). In general, UAL notably debulks adipose tissue with dramatic field exposure. Postoperative adhesions were present in all animals undergoing either monopolar or UAL dissection. Histology showed areas of foreign body reaction from mild to severe, with no predominance of either extreme seen with monopolar or UAL dissection. Cytologic analysis of collected pooled oil emulsion did not contain lymph node tissue.

Conclusion

The UAL approach permits pelvic lymphadenectomy in the obese animal and cadaver model, with excellent exposure of lymph nodes and surrounding pelvic anatomy. The use of a new ultrasonic prototype probe with a wider contact surface allowed dissection with less mechanical and thermal penetration of tissue. Further studies are needed to assess oncologic safety (cancer cell dissemination), postoperative healing, and adhesion formation.

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Acknowledgment

The authors acknowledge Drs. Gretchen Gleiser and Sanjeev Kumar for their assistance with the experiments. The authors also acknowledge Drs. Jordan Reynolds and Ronald Marler for the cytologic and pathologic analysis. This work was supported by Olympus Japan.

Disclosures

Christopher J. Gostout and the Developmental Endoscopy Unit receive research grant support from Olympus America and Olympus Tokyo. Dr. Gostout is an advisor to Apollo Endosurgery (Austin,Tx) and a consultant to Vysera (Galway, Ireland). Both he and the Mayo Foundation maintain an equity position in Apollo Endosurgery, Inc. Eduardo A Bonin, Andrea Mariani, James Swain, Juliane Bingener, Kazuki Sumiyama, Mary Knipschield, and Thomas J. Sebo have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Developmental Endoscopy Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Eduardo A. Bonin, Mary Knipschield & Christopher J. Gostout

  2. Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA

    Andrea Mariani

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    James Swain & Juliane Bingener

  4. Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan

    Kazuki Sumiyama

  5. Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA

    Thomas J. Sebo

Authors
  1. Eduardo A. Bonin
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  2. Andrea Mariani
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  3. James Swain
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  4. Juliane Bingener
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  5. Kazuki Sumiyama
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  6. Mary Knipschield
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  7. Thomas J. Sebo
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  8. Christopher J. Gostout
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Corresponding author

Correspondence to Christopher J. Gostout.

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Bonin, E.A., Mariani, A., Swain, J. et al. Laparoscopic ultrasound-assisted liposuction for lymph node dissection: a pilot study. Surg Endosc 26, 1963–1970 (2012). https://doi.org/10.1007/s00464-011-2136-9

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  • DOI: https://doi.org/10.1007/s00464-011-2136-9

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