Yanai Shiori, Kanno Kiyoshi, Sakate Shintaro, Sawada Mari, Aikou Kiyoshi, Yasui Michiru, Yoshino Yasunori, Shimada Kyoko, Andou Masaaki
Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.
Gynecol Oncol Rep. 2021 Apr 24;36:100768. doi: 10.1016/j.gore.2021.100768. eCollection 2021 May.
Robot-assisted extraperitoneal -aortic lymphadenectomy has been reported to be feasible option for the surgical management of gynecologic malignancy previously (Narducci et al., 2009) (Hudry et al., 2019). We have reported the feasibility of laparoscopic extraperitoneal total -aortic and pelvic lymphadenectomy (Andou, 2016). This article aims to show the safety of robot-assisted extraperitoneal "total -aortic and pelvic" lymphadenectomy. The video is the staging surgery for 67-year-old woman suspected clinical stage IA ovarian clear cell carcinoma after abdominal hysterectomy and salpingo-oophorectomy. As abdominal adhesion was predicted, she was treated using robot-assisted extraperitoneal total -aortic and pelvic lymphadenectomy. The patient was placed in the supine position and tilted 7 degrees to the right. Three robot arms were docked at the patient's left side. The center port was used for the scope. The bipolar cutting method was performed using the surgeon's right hand. An AirSeal® port (ConMed, Utica, NY, USA) was placed on the side near the assistant. After the extraperitoneal space was expanded, lymphadenectomy was performed up to the renal veins and below to the obturator muscles using the bipolar cutting method. This was followed by omentectomy. The operative time were 189 min, and the estimated blood loss was 75 ml. A total of 56 lymph nodes were harvested (22 -aortic lymph nodes and 34 pelvic lymph nodes). Total extraperitoneal lymphadenectomy by robot-assisted surgery was a feasible procedure for this patient. The procedure, which does not require the Trendelenburg position and is not obstructed by bowel, may be suitable for patients with hypertension, glaucoma, obesity or abdominal adhesion.
机器人辅助腹膜外主动脉旁淋巴结清扫术此前已被报道是妇科恶性肿瘤手术治疗的一种可行选择（纳尔杜奇等人，2009年）（胡德里等人，2019年）。我们曾报道过腹腔镜腹膜外全主动脉和盆腔淋巴结清扫术的可行性（安豆，2016年）。本文旨在展示机器人辅助腹膜外“全主动脉和盆腔”淋巴结清扫术的安全性。该视频是一名67岁女性在腹式子宫切除术和输卵管卵巢切除术后疑似临床IA期卵巢透明细胞癌的分期手术。由于预计存在腹部粘连，她接受了机器人辅助腹膜外全主动脉和盆腔淋巴结清扫术治疗。患者取仰卧位，向右倾斜7度。三个机器人手臂停靠在患者左侧。中心端口用于放置内镜。使用术者右手进行双极电切法操作。在助手附近一侧放置一个AirSeal®端口（康美公司，美国纽约尤蒂卡）。在扩大腹膜外间隙后，使用双极电切法向上至肾静脉、向下至闭孔肌进行淋巴结清扫。随后进行大网膜切除术。手术时间为189分钟，估计失血量为75毫升。共采集了56个淋巴结（22个主动脉旁淋巴结和34个盆腔淋巴结）。机器人辅助手术行全腹膜外淋巴结清扫术对该患者是一种可行的手术方式。该手术不需要头低脚高位且不受肠道干扰，可能适用于高血压、青光眼、肥胖或有腹部粘连的患者。
