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Para-aortic Lymphadenectomy for Gynecologic Cancers: Introducing the “Trans-Retro-Peritoneal (TRP) Single-Port Access”

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Abstract

Background

In gynecological surgery to date, two distinct types of endoscopic accesses have been used to perform para-aortic lymphadenectomies: transperitoneal and extraperitoneal, each with advantages and disadvantages.1 We propose to develop a new mini-invasive access to perform an endoscopic extraperitoneal para-aortic lymphadenectomy via a single-port umbilical device that, to our knowledge, has never been described.

Methods

This innovative approach combines both an extraperitoneal and intraperitoneal procedure via the same umbilical incision using one single trocar. A 3–4 cm trans-umbilical incision is performed and a three-channel single-port device (Gelpoint Mini°; Applied Medical, Rancho Santa Margarita, CA, USA) is introduced in the peritoneal cavity. After peritoneal exploration, the peritoneum overlying the aorta bifurcation is grabbed, raised to the umbilicus, opened, and the single-port device is then re-introduced into the retroperitoneal space.

Results

The intervention has been successful in three patients with locally advanced cervical cancer (two International Federation of Gynecology and Obstetrics [FIGO] stage IB2, and one FIGO stage IVA) scheduled for concomitant radiochemotherapy after exclusion of any suspicious lymph nodes by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), according to our standards of practice based on the European Society of Gynaecological Oncology (ESGO) and National Comprehensive Cancer Network (NCCN) guidelines.2,3 Due to the type of cancer, lymphadenectomy was limited to the infra-mesenteric nodes,2,4 although the dissection went up to the left renal vein in each case. We retrieved 13, 20, and 25 lymph nodes. No complications occurred.

Conclusions

We describe a promising technique that combines all the advantages of the two previously described accesses without their disadvantages, and with the cosmetic benefit of one almost invisible single trans-umbilical scar.

References

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    Beytout C, Laas E, Naoura I, Bendifallah S, Canlorbe G, Ballester M, et al. Single-port extra- and transperitoneal approach for paraaortic lymphadenectomy in gynecologic cancers: a propensity-adjusted analysis. Ann Surg Oncol. 2016;23(3):952–8.

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    Cibula D, Pötter R, Planchamp F, et al. Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Radiother Oncol. 2018;127:404–16.

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    Koh WJ, Abu-Rustum NR, Bean S, et al. Cervical cancer, Version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2019;17(1):64–84.

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    Azais H, Ghesquiere L, Petitnicolas C, et al. Pretherapeutic staging of locally advanced cervical cancer: inframesenteric paraaortic lymphadenectomy accuracy to detect paraaortic metastases in comparison with infrarenal paraaortic lymphadenectomy. Gynecol Oncol. 2017;147(2):340–4.

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Author information

Correspondence to Loïc Lelievre MD.

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Lelievre, L., Mathevet, P. Para-aortic Lymphadenectomy for Gynecologic Cancers: Introducing the “Trans-Retro-Peritoneal (TRP) Single-Port Access”. Ann Surg Oncol 26, 2540–2541 (2019) doi:10.1245/s10434-019-07379-8

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