Department of Surgery, Institut Gustave Roussy and University Paris Sud, Villejuif, France.
Int J Gynecol Cancer. 2011 Dec;21(9):1695-7. doi: 10.1097/IGC.0b013e31822a0175.
OBJECTIVE: We report the feasibility and the technique of single-port extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer. METHODS: The same single port was used for the transperitoneal step (to discriminate intraperitoneal disease) and the extraperitoneal approach used thereafter (in the absence of peritoneal or ovarian spread) for the lymphadenectomy. Para-aortic lymphadenectomy was performed via the left-sided extraperitoneal approach by a 2- to 3-cm incision, which was made 1 cm above the usual incision to the left of McBurney's point. We used conventional instruments in all cases. RESULTS: Three consecutive patients with cervical cancer had undergone a pretherapeutic laparoscopic staging procedure (1 stage IB2 and 2 stage IIB). The histologic types were squamous carcinoma (n = 2) and adenocarcinoma (n = 1). No patients had pelvic or para-aortic uptakes on preoperative positron emission tomography computed tomography imaging. The mean operative time was 223 minutes (range, 210-250 minutes). The mean number of lymph nodes removed was 19 (range, 15-23). The definitive pathological analysis had revealed that one patient had metastatic disease. No failures occurred with the single-port procedure, and no conversion to conventional multiport laparoscopy was reported. CONCLUSIONS: This preliminary series reports on the feasibility of the para-aortic lymphadenectomy technique via the extraperitoneal approach with a multichannel single port using conventional instruments. Nevertheless, the safety of this procedure (compared to conventional laparoscopic approach) needs to be explored in a further larger study.
目的:我们报告在局部晚期宫颈癌中单端口经腹腹膜外腹主动脉旁淋巴结清扫术的可行性和技术。
方法:同一端口用于经腹腔步骤(以区分腹腔内疾病),此后使用经腹膜外方法(无腹膜或卵巢转移)进行淋巴结清扫。通过 2 至 3cm 的切口从左侧经腹膜外途径进行腹主动脉旁淋巴结清扫,该切口位于麦氏点左侧常规切口上方 1cm 处。所有病例均使用常规器械。
结果:3 例连续宫颈癌患者接受了术前腹腔镜分期手术(1 例 IB2 期,2 例 IIB 期)。组织学类型为鳞状细胞癌(n=2)和腺癌(n=1)。术前正电子发射断层扫描计算机断层成像无盆腔或腹主动脉摄取。手术时间平均为 223 分钟(范围,210-250 分钟)。平均切除的淋巴结数为 19 个(范围,15-23 个)。明确的病理分析显示 1 例患者有转移疾病。单端口手术无失败,未报告转换为常规多端口腹腔镜。
结论:本初步系列报告了使用多通道单端口和常规器械经腹膜外途径进行腹主动脉旁淋巴结清扫术的可行性。然而,该手术的安全性(与传统腹腔镜方法相比)需要在进一步的更大研究中进行探讨。
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