A New Single-Port Approach to Perform a Transperitoneal Step and an Extraperitoneal Para-Aortic Lymphadenectomy with a Single Incision

Abstract

Chemoradiation therapy (CRT), a combination of external beam irradiation and brachytherapy with concurrent chemotherapy, is considered the standard treatment for bulky cervical cancer ( stage IB2 according to the International Federation of Gynecology and Obstetrics [FIGO] classification) by many North American and Western European teams. The incidence of para-aortic (PA) nodal metastasis n these tumors ranges from 10% to 25%. Positron emission tomography (PET) with or without CT imaging is the most accurate imaging modality for evaluating extrapelvic disease in locally advanced cervical cancer (LACC), When PA nodes are known to be metastatic, the radiation field is extended from the pelvis to include the PA area. However, the rate of false negatives at PET-CT assessment of PA metastasis in LACC is 12%, increasing to 22% if PET-CT reveals pelvic lymph nodes with suspicious metastases. The concept of surgical staging has gained momenum with the development of laparoscopy, which reduces urgical complications. Since January 2011, this surgical taging procedure has been performed more often in our nstitution using a single-port extraperitoneal approach, hich was previously described by our team. We have efined this procedure and developed a “real” single-port pproach avoiding a second transumbilical port (to explore he peritoneum), which was used in the first procedure. We eport in this series a new procedure for performing these wo steps via a single access with only one incision.