[Laparoscopic para-aortic and pelvic lymph node excision--initial experiences and development of a technique].

It was the aim of this study to establish and analyze the laparoscopic technique of para-aortic and pelvic lymphadenectomy. During a one year period (from August 1994 till July 1995) 42 patients underwent pelvic and para-aortic laparoscopic lymphadenectomy. In 29 cases cervical cancer, in 11 cases endometrial cancer and in 2 cases tumors of low malignant potential of the ovary were the indication for lymphadenectomy which was combined with radical vaginal hysterectomy in 19 patients or simple vaginal hysterectomy in 13 patients. During the observation period the mean operating time for para-aortic and pelvic lymphadenectomy decreased and the efficiency of the lymphadenectomy increased significantly: the mean operating time for the first 10 para-aortic lymphadenectomies was 52 minutes and for the pelvic lymphadenectomies 141 minutes, respectively. For the last 10 procedures the para-aortic part took 35 minutes and the pelvic part 110 minutes. Whereas at the beginning of the study a mean of 25 lymph nodes were removed, a mean of 36 lymph nodes were sampled during the last 10 procedures. In 3 patients operative injuries to major vessels were encountered of which two were followed by laparotomy. In 3 other patients laparotomy due to postoperative hemorrhage was necessary. These 6 complications occurred during the first half of the study and were not encountered during the following operations by changing from monopolar to bipolar coagulation and by modifying the regimen for perioperative thrombosis prophylaxis. In the first half of the study in 9 women blood transfusions were necessary and in the second half only 4 patients had to be transfused. In the first 10 patients the mean intraoperative blood loss was 1300 cc, in the last 10 patients 300 cc. After a short learning curve laparoscopic para-aortic and pelvic lymphadenectomy is a safe and effective technique for staging cervical, endometrial, and early ovarian cancers. Though this technique is no standard procedure results of this pilot study warrant prospective studies comparing this technique with conventional procedures.