Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France.
Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France.
J Minim Invasive Gynecol. 2018 Jul-Aug;25(5):765-766. doi: 10.1016/j.jmig.2017.10.019. Epub 2017 Oct 24.
Lumboaortic lymphadenectomy is frequently performed in the surgical management of different gynecologic pelvic malignancies: cervical endometrial and ovarian cancer. The retroperitoneal access presents a real advantage, allowing direct access to vascular axes, thus avoiding bowel segments. The use of a vessel-sealing device could facilitate the technique by providing an ergonomic alternative to conventional tools such as a bipolar grasper and scissors. Here the surgical technique of laparoscopic retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device in 10 steps is described.
Educative video (Canadian Task Force classification III).
Tertiary referral center in Strasbourg, France.
Women undergoing lumboaortic lymphadenectomy.
Laparoscopic retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device. The local institutional review board approved the video.
The surgeon and assistant are positioned on the left of the patient and the column is placed in front. After peritoneal exploration 3 trocars are introduced in the left flank according to a very precise arrangement. We use a camera scope with a zero-degree view angle. After development of the extraperitoneal space and identification of the vascular landmarks, lymphadenectomy using a vessel-sealing device involves several steps in an anticlockwise direction starting from the left common iliac group. We first start with the lateroaortic group of lymph nodes. We then continue with the preaortic, interaorticocaval, and precaval supramesenteric group. After that, we perform the inframesenteric dissection of lymph nodes, the bifurcation of the aorta, and finally the right common iliac group. At the end of the procedure, in the absence of signs of metastatic lymph nodes, we open the peritoneum.
Retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device is useful because of better ergonomics of the multitasking instrument, avoiding alternating between scissors and bipolar forceps. The surgeon will be able to use both hands for exposure and for surgery. The presence of a metastatic ganglion is an important and decisive factor in the choice of adjuvant or neoadjuvant management of cancers, especially for cervical cancer.
在不同妇科盆腔恶性肿瘤（宫颈内膜和卵巢癌）的外科治疗中，常行腹主动脉旁淋巴结切除术。后腹膜入路具有明显优势，可直接进入血管轴，从而避免肠段。血管密封装置的使用可通过为传统工具（如双极抓钳和剪刀）提供一种符合人体工程学的替代方法，从而促进该技术。此处描述了 10 步法腹腔镜后腹膜腹主动脉旁淋巴结切除术的手术技术，该技术使用血管密封装置。
教育性视频（加拿大任务组分类 III 级）。
法国斯特拉斯堡的三级转诊中心。
行腹主动脉旁淋巴结切除术的女性。
腹腔镜后腹膜腹主动脉旁淋巴结切除术，使用血管密封装置。局部机构审查委员会批准了该视频。
术者和助手位于患者左侧，柱位于术者前方。在进行腹膜探查后，根据非常精确的安排，在左侧肋腹处引入 3 个 trocar。我们使用具有零度视角的摄像镜。在开发腹膜外间隙并识别血管标志后，使用血管密封装置进行淋巴结切除术涉及沿逆时针方向进行的几个步骤，从左侧髂总组开始。我们首先开始进行后主动脉旁淋巴结组的手术。然后继续进行主动脉前、主动脉内-腔静脉间、腔静脉前肠系膜上淋巴结组的手术。之后，我们进行肠系膜内淋巴结的解剖、主动脉分叉和最后进行右侧髂总组的手术。在手术结束时，如果没有转移性淋巴结的迹象，我们打开腹膜。
使用血管密封装置进行后腹膜腹主动脉旁淋巴结切除术是有用的，因为多任务工具的操作更符合人体工程学，避免了在剪刀和双极抓钳之间交替使用。术者将能够同时使用双手进行暴露和手术。转移性淋巴结的存在是选择癌症辅助或新辅助治疗的重要和决定性因素，特别是对于宫颈癌。
