Uterine Cancer pp 223-229 | Cite as

Extraperitoneal Laparoscopic Para-aortic Lymphadenectomy in Endometrial Cancer: Rationale and Surgical Technique

  • Jo Marie Tran Janco
  • Sean C. DowdyEmail author


Extraperitoneal laparoscopic para-aortic lymphadenectomy is an increasingly utilized procedure in gynecologic oncology, with advantages over open or traditional laparoscopic surgery, namely, decreased propensity for postoperative adhesions and ability to complete thorough surgical staging in a minimally invasive fashion. For patients with endometrial carcinoma who are at high risk for dissemination to the para-aortic lymph nodes, this technique provides reliable access up to the level of the renal vessels and can be particularly helpful in obese patients.


Endometrial Cancer Renal Vein Endometrial Carcinoma Inferior Mesenteric Artery Endometrial Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

19.1 Video (M4V 110609 kb)

19.2 Video (M4V 311485 kb)

19.3 Video (M4V 110609 kb)


  1. 1.
    Querleu D, Dargent D, Ansquer Y, Leblanc E, Narducci F. Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Cancer. 2000;88:1883–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Dargent D, Ansquer Y, Mathevet P. Technical development and results of left extraperitoneal laparoscopic paraaortic lymphadenectomy for cervical cancer. Gynecol Oncol. 2000;77:87–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Gallup DG, King LA, Messing MJ, Talledo OE. Paraaortic lymph node sampling by means of an extraperitoneal approach with a supraumbilical transverse “sunrise” incision. Am J Obstet Gynecol. 1993;169:307–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, Munsell MF, Coleman RL, Soliman PT, Schmeler KM, Frumovitz M, Ramondetta LM. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer. 2011;117:1928–34.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    LeBlanc E, Gauthier H, Querleu D, Ferron G, Zerdoud S, Morice P, Uzan C, Lumbroso S, Lecuru F, Bats AS, Ghazzar N, Bannier M, Houvenaeghel G, Brenot-Rossi I, Narducci F. Accuracy of 18-fluoro-2-deoxy-D-glucose positron emission tomography in the pretherapeutic detection of occult para-aortic lymph node involvement in patients with a locally advanced cervical carcinoma. Ann Surg Oncol. 2011;18:2302–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Eisenhauer EL, Wypych KA, Mehrara BJ, Lawson C, Chi DS, Barakat RR, Abu-Rustum NR. Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy, or laparotomy with panniculectomy for the staging of uterine malignancy. Ann Surg Oncol. 2007;14:2384–91.CrossRefPubMedGoogle Scholar
  7. 7.
    Walker JL, Piedmonte M, Spitros N, Eisenkop S, Schlaerth J, Mannel R, Spiegel G. Phase III trial of laparoscopy (scope) vs. laparotomy (open) for surgical resection and comprehensive surgical staging of uterine cancer: a Gynecologic Oncology Group (GOG) study funded by NCI. Gynecol Oncol. 2006;101:S2.CrossRefGoogle Scholar
  8. 8.
    Kornblith A, Walker JL, Huang H, Celia D. Quality of life (QOL) of patients in a randomized clinical trial of laparoscopy (scope) vs. open laparotomy (open) for the surgical resection and staging of uterine cancer: a Gynecologic Oncology Group (GOG) study. Gynecol Oncol. 2006;101:S22.Google Scholar
  9. 9.
    Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, Levine DA, Brown CL, Chi DS, Barakat RR, Gemignani ML. Sentinel lymph node mapping for grade 1 endometrial cancer: is the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113:163–9.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Burke TW, Levenback C, Tornos C, Morris M, Wharton JT, Gershenson DM. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol. 1996;62:169–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Niikura H, Okamura C, Utsunomiya H, Yoshinaga K, Akahira J, Ito K, Yaegashi N. Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2004;92:669–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Mariani A, Webb MJ, Keeney GL, Podratz KC. Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer. Gynecol Oncol. 2001;81:100–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, Podratz KC. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109:11–8.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Mariani A, Webb MJ, Galli L, Podratz KC. Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecol Oncol. 2000;76:348–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar S, Mariani A, Bakkum-Gamez JN, Weaver AL, McGree ME, Keeney GL, Cliby WA, Podratz KC, Dowdy SC. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013;130:441–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Kohler C, Tozzi R, Klemm P, Schneider A. Laparoscopic paraaortic left-sided transperitoneal infrarenal lymphadenectomy in patients with gynecologic malignancies: technique and results. Gynecol Oncol. 2003;91:139–48.CrossRefPubMedGoogle Scholar
  17. 17.
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML, Sharma SK. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2. J Clin Oncol. 2009;27:5331–6.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Scribner DR, Walker JL, Johnson GA, McMeekin DS, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 2002;84:426–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Silver DF, Wheeless CR, Abbas FM. A vaginal and extraperitoneal approach to surgically stage patients with endometrial cancer. Gynecol Oncol. 2001;81:144–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Gouy S, Kane A, Uzan C, Gauthier T, Gilmore J, Morice P. Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy: about fourteen consecutive cases. Gyncol Oncol. 2011;123:329–32.CrossRefGoogle Scholar
  21. 21.
    Mehra G, Meekes ARL, Jacobs IJ, Visvanathan D, Menon U, Jeyarajah AR. Laparoscopic extraperitoneal paraaortic lymphadenectomy: a study of its applications in gynecologic malignancy. Gyncol Oncol. 2004;93:189–93.CrossRefGoogle Scholar
  22. 22.
    Nagao S, Fujiwara K, Kagawa R, Kozuka Y, Oda T, Maehata K, Ishikawa H, Koike H, Kohno I. Feasibility of extraperitoneal laparoscopic para-aortic and common iliac lymphadenectomy. Gynecol Oncol. 2006;103:732–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Dowdy SC, Aletti G, Cliby WA, Podratz KC, Mariani A. Extra-peritoneal laparoscopic para-aortic lymphadenectomy – a prospective cohort study of 293 patients with endometrial cancer. Gyncol Oncol. 2008;111:418–24.CrossRefGoogle Scholar
  24. 24.
    Lowe MP, Bahador A, Muderspach LI, Burnett A, Santos L, Caffrey A, Roman LD, Morrow CP. Feasibility of laparoscopic extraperitoneal surgical staging for locally advanced cervical carcinoma in a gynecologic oncology fellowship training program. J Minim Invasive Gynecol. 2006;13:391–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Occelli B, Narducci F, Lanvin D, LeBlanc E, Querleu D. Learning curves for transperitoneal laparoscopic and extraperitoneal endoscopic paraaortic lymphadenectomy. J Am Assoc Gynecol Laparosc. 2000;7:51–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Benito V, Lubrano A, Arencibia O, Andujar M, Pinar B, Medina N, Falcon JM, Falcon O. Laparoscopic extra-peritoneal para-aortic lymphadenectomy in the staging of locally advanced cervical cancer: is it a feasible procedure at a peripheral center? Int J Gynecol Cancer. 2012;22:332–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Wolf JS, Clayman RV, Monk TG, McClennan BL, McDougall EM. Carbon dioxide absorption during laparoscopic pelvic operation. J Am Coll Surg. 1995;180:555–60.PubMedGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Division of Gynecologic SurgeryMayo ClinicRochesterUSA

Personalised recommendations