Peng Shiyi, Zheng Ying, Yang Fan, Wang Kana, Chen Sijing, Wang Yawen
Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Obstetrics, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China.
Front Surg. 2022 Apr 15;9:863078. doi: 10.3389/fsurg.2022.863078. eCollection 2022.
Nowadays, lymphadenectomy could be performed by the transperitoneal or extraperitoneal approach. Nevertheless, each approach has its own advantages and disadvantages. Under these circumstances, we developed a transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy. In this research, the primary goal is to demonstrate the feasibility of the novel approach in systematic lymphadenectomy and present the surgical process step-by-step.
Between May 2020 and June 2021, patients who had the indications of systematic lymphadenectomy underwent lymphadenectomy via the TU-LESS extraperitoneal approach. This new approach was described in detail, and the clinical characteristics and surgical outcomes were collected and analyzed.
Eight patients with gynecological carcinoma were included in the research, including four with high-risk endometrial cancer and four with early-stage ovarian cancer. The TU-LESS extraperitoneal approach for pelvic and para-aortic lymphadenectomy was successfully performed in all patients without conversion. In all, a median of 26.5 pelvic lymph nodes (range 18-35) and 18.0 para-aortic lymph nodes (range 7-43) were retrieved. There was a median of 166.5 min of surgical time (range 123-205). Patients had speedy recoveries without complications. All patients had positive pain responses after surgery, as well as satisfactory cosmetic and body image outcomes.
Our initial experience showed that it is feasible to perform systematic lymphadenectomy with the TU-LESS extraperitoneal approach. And this new approach may provide a new measure or a beneficial supplement for lymphadenectomy in gynecologic cancer.
如今，淋巴结清扫术可通过经腹腔或腹膜外途径进行。然而，每种途径都有其自身的优缺点。在这种情况下，我们开发了一种经脐单孔腹腔镜（TU-LESS）腹膜外途径用于淋巴结清扫术。在本研究中，主要目的是证明这种新途径在系统性淋巴结清扫术中的可行性，并逐步展示手术过程。
在2020年5月至2021年6月期间，有系统性淋巴结清扫术指征的患者通过TU-LESS腹膜外途径接受了淋巴结清扫术。详细描述了这种新途径，并收集和分析了临床特征及手术结果。
8例妇科癌症患者纳入研究，其中4例为高危子宫内膜癌，4例为早期卵巢癌。所有患者均成功通过TU-LESS腹膜外途径完成了盆腔和腹主动脉旁淋巴结清扫术，无一例中转。总共，中位清扫盆腔淋巴结26.5枚（范围18 - 35枚），腹主动脉旁淋巴结18.0枚（范围7 - 43枚）。手术时间中位为166.5分钟（范围123 - 205分钟）。患者恢复迅速，无并发症。所有患者术后疼痛反应阳性，美容效果和身体形象满意度良好。
我们的初步经验表明，采用TU-LESS腹膜外途径进行系统性淋巴结清扫术是可行的。并且这种新途径可能为妇科癌症淋巴结清扫术提供一种新的措施或有益的补充。
