Extraperitoneal para-aortic lymphadenectomy: Laparoscopic single port approach

Objective. The authors present extra peritoneal para-aortic lymphadenectomy performed by single port laparoscopy in the case of bulky lymph nodes.Method. A 56 year old woman, affected by squamous carcinoma of the cervix, FIGO stage 1B2, with bulky common iliac and para-aortic lymph nodes at TC scan, was scheduled to extra peritoneal para-aortic lymphadenectomy. A 2 cm incision was made 2 cm above the traditional incision point described by Querleu. Open access of the lateral abdominal wall was performed and the surgeon's index finger was inserted to bluntly develop the retroperitoneal space. After the introduction of X-cone reusable single port device, insufflations of 12 mm Hg of carbon CO2 gas were performed. A 5 mm, 30 degrees laparoscope was placed into the right channel, curved atraumatic S-portal forceps into the left access and harmonic scalpel into the central channel. After retroperitoneal identification of the psoas muscle, iliac vessels, and ureter, additional development of the retroperitoneal space could be accomplished safely with blunt dissection till the identification of the left renal vein. The lymphadenectomy specifically targeted the left-sided supra and infra-mesenteric para-aortic spaces to remove the bulky lymph nodes detected by CT scan.Results. The operation was performed successfully with no intraoperative or postoperative complication. Operative time was 165 min. 9 lymph nodes were removed and no metastasis was detected. Dietary intake was started in day 0. Patient was discharged on day one.Conclusion. This report suggests that single port extra-peritoneal para-aortic lymphadenectomy in the case of bulky lymph nodes is feasible without particular differences in terms of anatomic exposition and technique from the multi-access approach.