Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.
J Gynecol Oncol. 2021 Jan;32(1):e6. doi: 10.3802/jgo.2021.32.e6. Epub 2020 Oct 22.
In comparison with laparoscopic transperitoneal para-aortic lymphadenectomy, the advantages of laparoscopic extraperitoneal para-aortic lymphadenectomy (ePAL) are that the operative field is not obstructed by bowel and the Trendelenburg position is not required [1]. The ePAL technique has been adopted to the robotic surgery with the da Vinci Xi. There are only a few reports demonstrating the technical feasibility of robot-assisted ePAL (RAePAL) [2 3]. This report describes the new surgical technique of RAePAL with the bipolar cutting method.
The patient was a 53-year-old woman diagnosed as ovarian clear cell carcinoma (CCC) after left salpingo-oophorectomy. As the re-staging surgery, robot-assisted right salpingo-oophorectomy, hysterectomy, omentectomy, and pelvic lymphadenectomy were planned following ePAL. The patient was placed in the supine position and tilted 5 degrees to the right. Three da Vinci arms were docked at the patient's left side (Fig. 1). The bipolar cutting method was performed by with the surgeon's right hand. An AirSeal® port (ConMed, Utica, NY, USA) was placed on the side near the assistant. After the para-aortic space was expanded, lymphadenectomy was performed up to the renal veins with the bipolar cutting method.
The PAL operative time was 155 minutes, estimated blood loss was 25 mL. The patient developed no perioperative complications, and the postoperative diagnosis was stage IC1 ovarian CCC with no pelvic (n=0/42) and para-aortic lymph nodes (n=0/59) metastasis.
RAePAL with the bipolar cutting method was technically feasible. Performing lymphadenectomy between the aorta and the vena cava was facilitated by the articulated robotic arm.
与腹腔镜经腹腔腹膜后淋巴结清扫术相比，腹腔镜腹膜外腹主动脉旁淋巴结清扫术（ePAL）的优势在于手术视野不受肠管的阻碍，且不需要采用头低脚高位[1]。ePAL 技术已被应用于达芬奇 Xi 机器人手术中。仅有少数报道证明了机器人辅助 ePAL（RAePAL）的技术可行性[2,3]。本报告介绍了一种采用双极切割法的新的 RAePAL 手术技术。
患者为 53 岁女性，因左侧输卵管卵巢切除术诊断为卵巢透明细胞癌（CCC）。作为分期手术，计划行机器人辅助右侧输卵管卵巢切除术、子宫切除术、网膜切除术和盆腔淋巴结清扫术，随后进行 ePAL。患者取仰卧位，向右侧倾斜 5 度。三个达芬奇机械臂在患者左侧对接（图 1）。采用双极切割法由术者右手操作。在助手附近的一侧放置 AirSeal®端口（康美，尤蒂卡，纽约，美国）。扩大腹主动脉旁间隙后，采用双极切割法进行淋巴结清扫，直至肾静脉。
PAL 手术时间为 155 分钟，估计出血量为 25 毫升。患者无围手术期并发症发生，术后诊断为 IC1 期卵巢 CCC，盆腔（n=0/42）和腹主动脉旁淋巴结（n=0/59）无转移。
采用双极切割法的 RAePAL 技术是可行的。 articulated 机器人臂有利于在主动脉和腔静脉之间进行淋巴结清扫。
