Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy (S, SI, and XI Systems)

  • Fabrice NarducciEmail author
  • Lucie Bresson
  • Delphine Hudry
  • Eric Leblanc



Here, we report the use of extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy in one cancer center.

Materials and Methods

Forty-one consecutive patients were described: 31 patients with the S system from Da Vinci and 10 with the Xi system.


Forty-one consecutive patients were analyzed (51 years, BMI 28) with the following types of cancer: cervical cancer (n = 27), endometrial cancer (n = 9), adnexal cancer (n = 4), and vaginal cancer (n = 1). Operative time, estimated blood loss, and the mean number of para-aortic lymph nodes resected were 207.2 (±61.2), 104.8 mL (±126.8 mL), and 19.7 (±10.5), respectively.

There was one failure with pneumoperitoneum in an obese patient without the possibility of transperitoneal para-aortic lymphadenectomy. Two other patients had failure with pneumoperitoneum, but they underwent transperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy. One patient had hemorrhage lateral to the IMA, so we used extraperitoneal laparoscopy for coagulation (hemorrhage, 600 mL, but no transfusion).

With a follow-up of 33 months, we reported 32% of postoperative complications, such as drainage of lymphocysts, lymphedema, and dysesthesia.


Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy exhibited rates of failure, preoperative complications, and postoperative complications of 2.5%, 2.5%, and 32%, respectively. Peritoneal marsupialization could be useful to reduce symptomatic lymphocysts, except in cases of macroscopically involved para-aortic lymph nodes.


Para-aortic lymphadenectomy Extraperitoneal laparoscopy Learning curve Gynecologic oncology Robot-assisted laparoscopy 

Supplementary material

Video 18.1

Robot extra Ao-placement of ballon trocar Film 18.1 (MOV 56168 kb)

Video 18.2

Robot extra Ao-placement of others trocars Film 18.2 (MOV 94374 kb)

Video 18.3

Extraperitoneal aortic robot Xi increase in the extra extraperitoneal space and placement of the cephalic 8-mm trocar and the 12-mm assistant trocar Film 18.3 (M4V 328880 kb)

Video 18.4

Extraperitoneal aortic robot Xi targeting Film 18.4 (M4V 24427 kb)

Video 18.5

Extraperitoneal aortic robot Xi left interiliac bifurcation and left ureter Film 18.5 (M4V 126482 kb)

Video 18.6

Extraperitoneal aortic robot Xi left renal vein Film 18.6 (M4V 330705 kb)

Video 18.7

Extraperitoneal aortic robot Xi common iliac arteries and aortic bifurcation Film 18.7 (M4V 151251 kb)

Video 18.8

Extraperitoneal aortic robot Xi right interiliac bifurcation right ureter Film 18.8 (M4V 83074 kb)


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Fabrice Narducci
    • 1
    Email author
  • Lucie Bresson
    • 1
  • Delphine Hudry
    • 1
  • Eric Leblanc
    • 1
  1. 1.Department of Gynecologic OncologyCancer Center Oscar LambretLille CedexFrance

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