Robotic Extraperitoneal Para-Aortic and Pelvic Lymphadenectomy with the Aid of the Double Bipolar Method

Abstract

Study Objective To evaluate the efficacy of robotic extraperitoneal paraaortic dissection using the double bipolar method (DBM). Design We will show our double bipolar technique and give retrospective analysis of data. Setting Urban general hospital. Patients or Participants From December 26th 2018 to April 22nd 2019, 13 patients underwent extraperitoneal paraaortic dissection and 3 patients underwent both paraaortic and pelvic extraperitoneal dissection for stage I ovarian cancer (n=5) and endometrial cancer (n=8)- stage I-III. Interventions Informed consent was gained from all patients. Underlaparoscopic observation, we accessed the retroperitoneal space at the lower left flank extraperitoneally using an Endotip cannula. We expanded the peritoneal pocket to establish pneumo-retroperitoneum. Four extraperitoneal trocars along the left flank were placed. The DBM was originated by a robotic gastrointestinal surgeon, Prof Ichiro Uyama. This technique uses Robotic Maryland forceps for both cutting and coagulation. The cutting device is set with a special energy platform at macromode 60W. The lightning strike cutting mechanism is more precise than other instrumentation such as monopolar scissors and causes minimal thermal spread to adjacent organs. Measurements and Main Results The median number of retrieved lymph nodes in the paraaortic dissection was 32, in the pelvic dissection- 27. The estimated blood loss in the paraaortic dissection was almost 0ml, and 75ml in the pelvic. The median operating time was 147mins for the paraaortic dissection and 50mins for the pelvic dissection. No patients who underwent these interventions suffered organ injury or required a blood transfusion. Conclusion Extraperitoneal approach has the advantage of being a no-bowel operative field. The DBM makes it possible to perform accurate, bloodless dissection making it applicable to extended retroperitoneal dissection. The combination of this approach and technique can potentially be applied to total retroperitoneal dissection including para-aortic and pelvic lymphadenectomy cases.