Laparoscopic extraperitoneal lumboaortic lymphadenectomy in 10 steps – Let's make it easier!

Abstract

ObjectiveLaparoscopic extraperitoneal lymphadenectomy has both advantages of minimally invasive approach and retroperitoneal access. Although procedure is described for more than two decades there is a lack of diffusion of the technique. Standardization and simple description of the technique is main objective of this video. We described this procedure in 10 logical steps which could help to understand and perform this procedure. MethodsThis video presents systematic approach to extraperitoneal lumboaortic lymphadenectomy which was clearly divided in ten steps ordered in a counter-clockwise direction. ResultsStep 1:Retroperitoneal access and introduction of trocarsStep 2:Creating of a space for subsequent lymphadenectomy and identification of anatomical landmarksStep 3:Left common iliac lymph nodes dissectionStep 4:Latero-aortal lymph nodes dissectionStep 5:Aorto-caval lymph nodes dissectionStep 6:Latero-caval lymph nodes dissectionStep 7:Right common iliac lymph nodes dissectionStep 8:Presacral lymph nodes dissectionStep 9:Fenestration of peritoneumStep 10:Extraction of bags with specimens ConclusionsLaparoscopic extraperitoneal access to lumboaortic lymph nodes is an effective method of lymphadenectomy which may bring benefits to a patient and physician. Presented ten steps help to perform each part of surgery in logical sequence making procedure ergonomic, easier to adopt and learn. Prior development of operative area in the extraperitoneal space followed by identification of anatomical landmarks is an important step which should precede lymph node dissection. Standardization of laparoscopic techniques could help to reduce learning curve.