Robotic Transperitoneal Infrarenal Aortic Lymphadenectomy for Gynecologic Malignancy: A Left Lateral Approach

Objective:

To describe the technique of a left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy with subsequent pelvic surgery in patients with gynecologic malignancy.

Methods:

Our surgical technique utilized an extreme right tilt position to obtain optimal exposure of bilateral aortic regions. A total of six trocars were used for both the aortic and pelvic dissections. The robot was docked over the left hip. The dissection began left lateral with transperitoneal mobilization of the ureter and descending colon. The cephalad borders of the dissection were the left renal vein and the right gonadal vein insertion. After the aortic dissection, sterility was maintained and the operating table rotated 45° degrees for caudal docking during pelvic surgery. Patient outcome data were collected and analyzed. ¹

Results:

The median total operating time was 213 minutes (range, 186–265) for all procedures. All patients underwent concomitant robotic hysterectomy and pelvic lymphadenectomy. The mean number of para-aortic lymph nodes was 8.2 (range 4–17). There were no conversions or perioperative complications.

Conclusions:

A left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy using a right lateral decubitus position is safe and feasible. Minimal patient repositioning provides access for pelvic surgery using the same abdominal trocar placement.

No competing financial interests exist.

Runtime of video: 5 mins 5 secs