Institut Paoli Calmettes, Oncology Surgery 2, 232 Boulevard Sainte Marguerite, Marseille, France.
Aix-Marseille University, Inserm, CNRS, Institut Paoli Calmettes, CRCM, Marseille, France.
J Gynecol Oncol. 2019 Sep;30(5):e74. doi: 10.3802/jgo.2019.30.e74.
Para-aortic lymphadenectomy was the cornerstone of gynecologic oncology surgery. In endometrial cancer, the quality of para-aortic lymphadenectomy had direct impact on survival of patient. The launch of robot assisted laparoscopy started in 2005 in France, and in 2008 a transperitoneal para-aortic lymphadenectomy was described [1]. With the increase of robots, the robot assisted laparoscopy became more and more popular, hence the need of video tutorial to help less experienced surgeon in this surgical procedure [2].
We proposed a description in 10 key steps, of a transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy (Da Vinci® Si or Xi Robot Surgical System; Intuitive Surgical Inc., Sunnyvale, CA, USA), without other surgical procedure.
The 10 steps are: Step 1: port placement and Da Vinci robot positioning Step 2: identification of the right ureter Step 3: identification of the left renal vein Step 4: latero-caval and aorto-caval lymph nodes dissection Step 5: identification of the left ureter Step 6: creation of peritoneal tent Step 7: identification of the inferior mesenteric artery Step 8: latero-aortal lymph nodes dissection Step 9: pre-sacral lymph nodes dissection Step 10: extraction of bags with specimen and surgical textile.
A standardization of transperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy is the basis of teaching and learning process. Also it increases the quality of surgery, and consequently decreases the risk of complications.
腹主动脉旁淋巴结清扫术是妇科肿瘤外科的基石。在子宫内膜癌中，腹主动脉旁淋巴结清扫术的质量直接影响患者的生存。机器人辅助腹腔镜手术于 2005 年在法国推出，2008 年描述了经腹腔腹主动脉旁淋巴结清扫术[1]。随着机器人数量的增加，机器人辅助腹腔镜手术越来越受欢迎，因此需要视频教程来帮助经验不足的外科医生掌握这项手术[2]。
我们提出了 10 个关键步骤，描述了机器人辅助腹腔镜下经腹腔腹主动脉旁淋巴结清扫术（达芬奇® Si 或 Xi 机器人手术系统；直观外科公司，加利福尼亚州森尼韦尔），无需其他手术。
这 10 个步骤是：步骤 1：端口放置和达芬奇机器人定位；步骤 2：识别右输尿管；步骤 3：识别左肾静脉；步骤 4：侧腔静脉和腹主动脉淋巴结清扫；步骤 5：识别左输尿管；步骤 6：创建腹膜帐篷；步骤 7：识别肠系膜下动脉；步骤 8：侧主动脉淋巴结清扫；步骤 9：骶前淋巴结清扫；步骤 10：提取带有标本和手术纺织品的袋子。
机器人辅助腹腔镜下经腹腔腹主动脉旁淋巴结清扫术的标准化是教学和学习过程的基础。它还提高了手术质量，从而降低了并发症的风险。
