Vaginal Extraction Research Articles

Defining a Uterine Extraction Score based on a Volume/Access Ratio in Total Hysterectomy: a retrospective cohort study.

Regardless of the technique used, extraction of the uterus is a crucial step in hysterectomy. There is currently no scoring system to predict its feasibility. Our main objective was to determine a predictive score of uterine extraction feasibility to optimise surgical planning of total hysterectomy. As secondary objectives, we examined the correlation between uterine volume predicted by preoperative ultrasound and the final weight of the surgical specimen and analysed the impact of the uterine extraction modality on operative and hospitalisation times. We defined a Uterine Extraction Score (UES) based on the ratio between uterine sizes and vaginal access. This score was retrospectively applied to a cohort of 178 patients who were hysterectomised for benign conditions between January 2019 and December 2022. The UES allows identification of three groups of decreasing feasibility of vaginal extraction, symbolised by traffic light colours: green - vaginal extraction without morcellation, orange -vaginal extraction with morcellation, red - abdominal morcellation by mini-laparotomy or primary laparotomy. The results show that the UES--predicted, and the observed routes of extraction concord in 92% of cases. There is a strong correlation between estimated volume and final uterine weight. Uterine morcellation lengthens the operative time and the hospital stay. The UES seems to be a reliable tool to predict the route of uterine extraction in total hysterectomy. The development of a new scoring system empowers surgeons with decisive information to enhance perioperative outcomes.

A Huge Vaginal Prolapse of Uterine Leiomyoma Complicated with Cervical Inversion: A Case Report

Introduction: Uterine fibroids are non-malignant neoplasms originating from the smooth muscle cells of the uterus, and they represent the most prevalent tumor seen within the female reproductive system. The primary established approach to manage this condition is surgical interventions, specifically myomectomy, hysterectomy, or hysteroscopic removal of small subserous nodules. Occasionally, submucous fibroids may protrude through the cervical os, thereby enabling the feasibility of performing a vaginal hysterectomy. Case Presentation: The clinical presentation of a 44-year-old multiparous woman who arrived with symptoms of vaginal bleeding and a sizable mass protruding through the vaginal opening. The patient underwent an emergency vaginal extraction to remove the mass measuring 24 cm in the emergency room and a scheduled for elective surgery. During the procedure, uterine inversion was found with a muscle bundle around the corpus uteri and a fourth-grade perineal tear. This patient was also planned for a total abdominal hysterectomy and bilateral-salphyngo-oophorectomy procedure, along with Haultain's procedure and perineal repair. The patient exhibited favorable surgical outcomes. Conclusion: Hysterectomy is the preferred therapy for prolapsed pedunculated submucous myoma. It has been seen that even exceptionally big nascent myomas can be effectively removed using vaginal means.

Vaginal Extraction Index: A Predictive Model for Vaginal Extraction of Specimens during Minimally Invasive Hysterectomy

Vaginal Extraction Index: A Predictive Model for Vaginal Extraction of Specimens during Minimally Invasive Hysterectomy

Radical Hysterectomy After the LACC Trial: Back to Radical Vaginal Surgery

Classical radical vaginal hysterectomy first performed by Anton Pawlik in Prague in 1888 and popularized by Frederic Schauta is now a historical technique virtually abandoned due to painful perineal incision, a high rate of urinary dysfunction, and the inability to perform lymph node assessment. However, the heritage of this approach has been still used and taught in a few centers outside their Austrian birthplace. A combined vaginal and laparoscopic approach was developed in the 1990s by French and German surgeons who designed diverse surgical techniques for which a novel classification is proposed. All these techniques are different from the so-called laparoscopically assisted radical vaginal hysterectomy (LARVH), a term widely used for laparoscopic radical hysterectomies with vaginal extraction of the specimen. Interestingly, after the publication of the LACC trial (Laparoscopic Approach to Cervical Cancer), the radical vaginal approach has found a very timely application. The creation of a vaginal cuff before performing radical laparoscopic hysterectomy described in 2007 by Leblanc as "Schautheim" operation can be used as a protective maneuver to avoid tumor spillage and potentially overturn the negative outcome of minimally invasive surgery in early-stage cervical cancer. As a result, the combination of radical vaginal and laparoscopic steps of surgery is one possible evolution after the LACC trial that needs further investigation. The forgotten vaginal surgical technique needs a specific learning curve. The creation of a vaginal cuff should be mastered by every gynecological oncologist.

Oral administration of maternal vaginal microbes at birth to restore gut microbiome development in infants born by caesarean section: A pilot randomised placebo-controlled trial.

BackgroundBirth by caesarean section (CS) is associated with aberrant gut microbiome development and greater disease susceptibility later in life. We investigated whether oral administration of maternal vaginal microbiota to infants born by CS could restore their gut microbiome development in a pilot single-blinded, randomised placebo-controlled trial (Australian New Zealand Clinical Trials Registry, ACTRN12618000339257).MethodsPregnant women scheduled for a CS underwent comprehensive antenatal pathogen screening. At birth, healthy neonates were randomised to receive a 3 ml solution of either maternal vaginal microbes (CS-seeded, n = 12) or sterile water (CS-placebo, n = 13). Vaginally-born neonates were used as the reference control (VB, n = 22). Clinical assessments occurred within the first 2 h of birth, and at 1 month and 3 months of age. Infant stool samples and maternal vaginal extracts from CS women underwent shotgun metagenomic sequencing. The primary outcome was gut microbiome composition at 1 month of age. Secondary outcomes included maternal strain engraftment, functional potential of the gut microbiome, anthropometry, body composition, and adverse events.FindingsDespite the presence of viable microbial cells within transplant solutions, there were no observed differences in gut microbiome composition or functional potential between CS-seeded and CS-placebo infants at 1 month or 3 months of age. Both CS groups displayed the characteristic signature of low Bacteroides abundance, which contributed to a number of biosynthesis pathways being underrepresented when compared with VB microbiomes. Maternal vaginal strain engraftment was rare. Vaginal seeding had no observed effects on anthropometry or body composition. There were no serious adverse events associated with treatment.InterpretationOur pilot findings question the value of vaginal seeding given that oral administration of maternal vaginal microbiota did not alter early gut microbiome development in CS-born infants. The limited colonisation of maternal vaginal strains suggest that other maternal sources, such as the perianal area, may play a larger role in seeding the neonatal gut microbiome.FundingHealth Research Council of New Zealand, A Better Start – National Science Challenge.

Comparison of Long-Term Outcomes of Standard and Transvaginal Kidney Extraction in Laparoscopic Living Donor Nephrectomy.

Background: A limited number of publications are available in the literature regarding laparoscopic living donor nephrectomy with vaginal extraction (LLDN-VE) for kidney transplantation. The aim of this study was to compare long-term recipient outcomes of standard laparoscopic living donor nephrectomy (S-LLDN) and LLDN-VE. Methods: A total of 652 patients [119 LLDN-VE (18.3%) and 533 S-LLDN (81.7%)] were included in this retrospective cross-sectional study. The data related to donor and recipient demographics, surgical and anatomical characteristics, and recipient and graft status were retrieved and compared using nonparametric statistical methods. Kaplan-Meier and Cox proportional hazards regression analyses were applied to compute survival according to the surgical technique. Results: The mean follow-up duration was 73.0 ± 25.4 months for S-LLDN and 69.8 ± 20.4 months for LLDN-VE recipients. The main determinants of long-term outcomes were the serum creatinine (SCr) levels, death-censored graft survival, and recipient survival at the end of the post-op 5th year. LLDN-VE recipients' discharge SCr was found to be statistically lower (P = .049) than S-LLDN patients. Graft survival rates censored for death were 93.8% for the S-LLDN and 93.3% for the LLDN-VE recipients. Cox regression analysis showed significance for younger donor age (P = .010) with the application of 17 parameters, indicating better graft survival outcomes for kidney recipients with younger donors. Conclusions: Compared with the standard method, the long-term results of LLDN-VE are in accordance with or could even be more advantageous than S-LLDN in certain aspects. LLDN-VE appears to be a feasible, safe, and cosmetically superior approach with no negative postoperative sexual or morbid effects on the donor.

Natural orifice specimen extraction surgery in laparoscopic pancreaticoduodenectomy: A single-center case series.

Laparoscopic pancreaticoduodenectomy is an appealing and minimally invasive method for pancreaticoduodenal tumors. However, an abdominal incision is still required to extract the specimen. We used the natural orifice specimen extraction technique in laparoscopic pancreaticoduodenectomy to accomplish specimen retraction in 8 female patients and summarized the clinical results. A total of 8 female patients with periampullary carcinoma or duodenal cancer who underwent laparoscopic pancreaticoduodenectomy were enrolled in our study between April 2018 and October 2019. A 4-cm transverse incision was made in the posterior vaginal wall, and the specimen was extracted via the vagina. Age, operative time, intraoperative hemorrhage, pathological data of the tumor, postoperative hospital stay, and postoperative complications were recorded and analyzed. All operations were performed laparoscopically, by the same team of surgeons. The mean age of the patients was 67.5±7.7 years. Mean BMI was 23.7±1.7kg/m2. The operative time ranged between 312 and 460min. The intraoperative blood loss ranged from 100 to 600ml. The average hospital stay of all patients was 9.9±2.2 days; 5 out of 8 patients (62.5%) had postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, and postpancreatectomy hemorrhage. No patient developed short-term complications due to vaginal extraction of specimens. All patients underwent R0 resection. Transvaginal specimen extraction is a practicable method for laparoscopic pancreaticoduodenectomy. By adhering to correct operation specifications and selecting patients with appropriate indications for natural orifice specimen extraction, this technique was safe and beneficial to selected female patients with pancreaticoduodenal tumors.

Association of uterine dimensions and route of contained morcellation following laparoscopic hysterectomy.

The aim of this study was to determine if uterine dimensions on preoperative imaging are associated with route of contained morcellation during laparoscopic hysterectomy. This is a prospective cohort study of patients undergoing laparoscopic hysterectomy and requiring morcellation for specimen extraction from March 2017 through August 2019. A contained extraction system was inserted and manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction. A total of 47 patients were treated. Median age was 47 (range 38-70). Morcellation was performed vaginally for 29 patients (61.7%), abdominally for 13 patients (27.7%), and via combined approach for 5 patients (10.6%). The combined group had the highest frequency of patients who were black (vaginal: 24%, abdominal: 31%, combined: 100%; P=0.005), the longest median total operating time (vaginal: 167 minutes, abdominal: 183 minutes, combined: 268 minutes; P=0.006) and the longest median time of uterine morcellation (vaginal: 14 minutes, abdominal: 37 minutes, combined: 85 minutes; P<0.001). There was strong evidence of a positive correlation with time of uterine morcellation for both largest uterine diameter (Spearman's r: 0.62, P<0.001) and uterine volume (Spearman's r: 0.70, P<0.001). These associations remained consistent after multivariable linear regression models that were adjusted for route of morcellation, hysterectomy type, and BMI (both P<0.001). Larger uterine dimensions are associated with increased total operating and morcellation times. Uterine size and volume on preoperative imaging were not associated with route of morcellation, but there was a trend towards failed vaginal extraction when uterine dimensions exceeded 16 centimeters.

2080 Strategies for Difficult Hysterectomies

Video Objective Demonstrate alternative surgical approaches for difficult hysterectomies. Setting Multiple Cases of Hysterectomies with Challenging circumstances. Interventions Multiple Cases of Hysterectomies with Challenging circumstances with strategies for getting an alternative approach. 1. 30° angle Scope for better visualization 2. Decompression for vaginal extraction 3. Traction of the angles of vaginal cuff 4. Bladder Distention 5. Blunt Dissection 6. Cold Dissection 7. Power Morcellation 8. Identify Retroperitoneal Structures. Conclusion These strategies are useful to perform complex surgery and reduce the risk of complications

2003 Association of Pre-Operative Uterine Dimensions and Success of Contained Morcellation Following Minimally Invasive Hysterectomy

Study Objective To determine if uterine dimensions on pre-operative imaging are associated with success of contained morcellation during minimally invasive hysterectomy. Design Canadian Task Force Classification Level of Evidence II-2 Setting Surgical patients in a single metropolitan academic institution. Patients or Participants Patients undergoing laparoscopic or robotic hysterectomy and requiring morcellation for specimen extraction from March 2017 through April 2019 Interventions At the completion of surgery, a contained extraction system was inserted, and the specimen was placed within the bag. Manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction. Morcellation times were recorded. Medical records were reviewed to abstract demographic and clinical data. Measurements and Main Results A total of 39 patients were treated. Median age was 47 (range 25 – 70) and mean length of stay was 0.74 days. There were no conversions to laparotomy, readmissions, or surgical site infections within 30 days after surgery. Morcellation was performed vaginally for 24 patients (61.5%), abdominally for 10 patients (25.6%), and via combined approach for 5 patients (12.8%). Largest uterine dimension on imaging was median 12.6 centimeters (range 6 – 19.7) in the vaginal group, 11.9 (7.2 – 20) in the abdominal group, and 16.4 (14.1 – 23) in the combined group (p=0.046). Both morcellation time (mean 19.7 minutes vaginal, 38.9 abdominal, 78.6 combined; p Conclusion Larger uterine dimensions are associated with failed vaginal extraction, and pre-operative imaging can assist with surgical decision-making. Providers need to be deliberate when choosing route of specimen removal, as morcellation and total operating time significantly increase when vaginal morcellation is unsuccessful.

A simple sonographic finding is associated with a successful vacuum application: the fetal occiput or forehead sign

Intrapartum ultrasound scanning has been proposed as an ancillary tool in the decision-making process of instrumental vaginal delivery. The purpose of this study was to evaluate the correlation between the sonographic visualization with a transperineal scan of the fetal occiput or forehead distal to the pubic symphysis with anterior or posterior presentation, respectively (fetal occiput or forehead sign), and the outcome of a vacuum delivery. We conducted a retrospective cohort study of patients who underwent a vacuum application in our hospital from 2011-2017, excluding outlet applications. In each case, a preliminary transperineal scan was performed to confirm fetal presentation and position and to demonstrate the presence or absence of the fetal occiput or forehead sign. The head direction, angle of progression, and the head perineum distance were also noted. The primary outcome measure was the success of the vacuum. The secondary outcome measures included fetal complications and perineal lacerations. A total of 196 consecutive patients were enrolled in the study. The occiput or forehead sign was present in 150 and was associated with a successful vaginal extraction in all cases. Of the 46 cases without the sign, 5 babies (10.8%) were delivered by cesarean section after a failed vacuum (P=.0006). The occiput or forehead sign was also associated with fewer grade 3-4 perineal lacerations (10.7% vs 35.7%; P=.0005) and cephalohematomas, although the difference was not statistically significant (1.4% vs 4.3%). There was a good correlation between the occiput or forehead sign and the other sonographic methods that previously had been proposed to predict a successful vacuum extraction, such as head direction, angle of progression, and head perineum distance. In our hands, the fetal occiput or forehead sign was associated strongly with successful vacuum application and with a very low rate of maternal and fetal complications.

Mummification of Triplets in a Doe

Fetal mummification is a rare gestational accident in domestic animals which is associated with fetal death, non-involution of corpus luteum, absorption of fetal and placental fluid and other associated changes in uterine environment. The present case report describes per vaginal extraction of three mummified fetuses of different stage of gestation in a four year non descriptive doe.

Peculiarities of microbiological monitoring in the pathological status of the vegina and cervix in women of reproductive age

Vulvovaginal and cervical infections are a risk factor of developing purulent inflammatory diseases of the pelvic organs, miscarriage, antenatal and intranatal infections, with frequent pathogens Ureaplasma, Mycoplasma, Gardnerella vaginalis, Bacterioides. Particular importance is given to the mix-infection as a reservoir of a large number of different potentially harmful microorganisms. The purpose of our study was to study the specific composition of microorganisms in women of reproductive age with pathological secretions from the genital tract and to determine the incidence of genitalurea / mycoplasmosis. 54 patients of reproductive age with complaint on itch, heartburn, excessive secretions from the non-slippery genital tract and / or with an unpleasant smell, which were repeated 2 or more times during the year after the treatment, were examined. During gynecological examination, the following diseases were detected in patients: erosion of the cervix in 8 (14.8%) patients, cervicitis in 6 (11.1%), cervical cyst in 2 (3.7%) women, leukoplakia in 3 (5,55%) of the surveyed. According to the results of bacterioscopy, bacterial vaginosis was detected in 4 (7.4%) patients, unspecified bacterial colpitis — 28 (51.8%), vaginal candidiasis — in 17 (31.5%). In cytological screening, CIN I was diagnosed in 9 (16.6%) subjects, CIN II in 4 (7.4%). Analyzing the results of the study conducted by the polymerase chain reaction of HPV-infection was found in 8 (14,8%), ureaplasma — in 14 (25,9%), mycoplasma — in 6 (11,1%) patients. Staphylococcus aureus 105 — 4 (7.4%), Staphylococcus epidermidis 103 — 1 (1.8%), E. coli 105 — 7 (12.9%), Enterococcus, were detected during bacteriological examination of vaginal and cervical extracts. Fecalis 106 — 9 (16.6%), Candida albicans 105 — 6 (11.1%), Clebsiela 106 — 3 (5.5%), Gardnerella vaginalis 107 —11 (20.3%), Streptococcus 106 — 5 (9.2%). Thus, diagnosed high percentage (22.2%) ureaplasmas combination with other types of conditional — pathogenic microorganisms and viruses and cervical pathology (13%), namely the combination of ureaplasma pathogenic microflora was observed in 8 (14.8%) cases of HPV — 6 (11.1%), with mycoplasma, and pathogenic microflora — 5 (9.3%) patients. In general, 35.2% of cases. Assessing the infection of reproductive age women ureaplasma and mycoplasma less with recurrent abnormal discharge from the genital tract after treatment leads to the search and introduction of modern methods of their diagnosis and treatment.

Prospective Evaluation of Manual Morcellation Techniques: Minilaparotomy versus Vaginal Approach

Study ObjectiveTo compare the number of days required to return to daily activities after laparoscopic hysterectomy with 2 tissue extraction methods: manual morcellation via colpotomy or minilaparotomy. Secondary outcomes were additional measures of patient recovery, perioperative outcomes, containment bag integrity, and tissue spillage. DesignMulticenter prospective cohort study and follow-up survey (Canadian Task Force classification II-2). SettingTwo tertiary care academic centers in northeastern United States. PatientsSeventy women undergoing laparoscopic hysterectomy with anticipated need for manual morcellation. InterventionsTissue extraction by either contained minilaparotomy or contained vaginal extraction method, along with patient-completed recovery diary. Measurements and Main ResultsRecovery diaries were returned by 85.3% of participants. There were no significant differences found in terms of average pain at 1, 2, or 3 weeks after surgery or in time to return to normal activities. Patients in both groups used narcotic pain medication for an average of 3 days. After adjusting for patient body mass index, history of prior surgery, uterine weight, and surgeon, there were no differences found for blood loss, operative time, length of stay, or incidence of any intra- or postoperative complication between groups. All patients had benign findings on final pathology. More cases in the vaginal contained extraction group were noted to have bag leakage on postprocedure testing (13 [40.6%] vs 3 [8.3%] tears in vaginal and minilaparotomy groups, respectively; p = .003). ConclusionRegarding route of tissue extraction, contained minilaparotomy and contained vaginal extraction methods are associated with similar patient outcomes and recovery characteristics.

Outcome of Surgical Induction of Labourin a Combined Military Hospital

Induction of labour is considered justified when the benefits of prompt delivery outweigh the consequences of Caeserian Section (CS). Literature on the effectiveness and safety of surgical induction of labour in term and postdated pregnancy is limited in Bangladesh. This study was aimed to assess the effectiveness and safety of surgical induction of labour in term and postdated pregnancy.This prospective clinical study was conducted in the in-patient Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka from July, 2005 to June 2006. A total of 100 pregnant women with term and postdated pregnancy were selected for the study by simple random sampling. The particulars of the patient, detailed menstrual and obstetric history, induction delivery interval, mode of delivery and foetal outcome and maternal complications were recorded. The results were analysed by Statistical Package for Social Science (SPSS) version 16.0.The mean±SD age of the participants was 25.79±6.16 years with a range of 18-38 years. The indication of Induction of labour included term pregnancy (79%) and postdated pregnancy (21%).Normal vaginal delivery was done in 78% cases, CS in 17% cases and vacuum extraction in 5% cases.Ninety three percent babies were born healthy, 6% were asphyxiated, perinatal death 2% and still born 1%. O2 inhalation was needed for 6% babies. Prolonged second stage (7%), post-partum haemorrhage (8%), maternal distress during labour (10%) and manual removal of placenta (12%) were the observed maternal complications.No significant difference was observed between term and post term pregnancy in the term of normal vaginal delivery, vacuum extraction and lower uterine cesarean section.Induction of labour is beneficial for both term and postdated pregnancy with associated complications. Foetal outcome was good and maternal complications were acceptable.Bangladesh Med Res Counc Bull 2018; 44(1):52-58

Case Series of Laparoscopic Retroperitoneal Hysterectomy: Outcomes, Cost and Patient Satisfaction [11D

INTRODUCTION: Laparoscopic Retroperitoneal Hysterectomy (LRH) is a minimally invasive hysterectomy approach incorporating retroperitoneal dissection to ligate the uterine arteries at the origin, lateralization of ureters, vaginal specimen extraction and transvaginal cuff closure. Our study evaluates LRH in terms of outcomes, cost, and patient satisfaction. METHODS: Retrospective chart review of 756 consecutive cases undergoing LRH for benign indications at a suburban hospital from 2011-2013. Data collected: patient characteristics and surgical outcomes. Direct hospital costs were estimated using a combination of micro- and gross-costing. Satisfaction surveys were mailed to the same patient population with a 12% response rate. RESULTS: Mean uterine size: 328.9g (SD 343.1), ranging from 20g to 9,314g. Mean operating time (OT): 61.8 min (SD 31.0). Average length of stay (LOS) 0.2 (SD 0.5) days with 88% discharged same day. Intraoperative and postoperative complication rates: 2.2% and 3.2%, respectively. Conversion to mini-laparotomy (&lt;5cm) = 1.2% (9 cases). Conversion to laparotomy (&gt;5cm) = 0.0%. Zero use of power morcellation. Average cost per case $4,061. Postoperative survey indicated 87.2% overall patient satisfaction rate. CONCLUSION: A distinguishing aspect of the LRH procedure is a standard retroperitoneal dissection with delineation of the ureter and control of the blood supply by uterine artery ligation at its origin. This technique is key to low complication rates, which minimizes OT, LOS, and costs, and contributes to patient satisfaction, and costs, and contributes to patient satisfaction. Further studies comparing LRH to the most widely performed minimally invasive hysterectomy approaches are warranted for this effective and cost-efficient procedure.

91 - Vaginal Extraction Index: A Predictive Model for Extraction of Hysterectomy Specimens

Study Objective: To determine the “Vaginal Extraction Index” as a predictive model for vaginal extraction that could assist gynecologic surgeons in preoperatively determining the likelihood of success in delivering an intact uterine specimen through the vagina following laparoscopic hysterectomy.

457 - Vaginal Extraction for Mesenchymal Tumor

It is one of topics that how to extract huge specimen in laparoscopic surgery. In gynecologic laparoscopic surgery, we have three pathways, trocar site, additional scar and vaginal extraction. In our hospital, we peform vaginal extraction in laparoscopic myomectomy and hysterectomy. I show the operation video and explain our operative procedure. We have modified diamond trocar placement for benign disease. In association with extraction specimen, I report the frequency of the unexpected malignancy in our hospital between 1994 and 2015. To tal number of cases performed operation for uterine mesenchymal tumor is 9581.51 are malignannt. 11 were not suspected as malignnacy by preoperative cytology and imaging test.(0.11%) 3 had normal range of lactate dehydrogenase(LDH).(0.03%).

476 - Robotic-Assisted Hysterectomy for Endometrial Cancer: Comparing Outcomes of Two Methods for Intact Uterine Extraction

Study Objective: The objective of this study was to compare peri-operative outcomes among patients with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH) with either vaginal extraction of the uterine specimen or RALH with uterine extraction via extended incision secondary to large uteri.

Laparoscopic Transperitoneal Para-Aortic Lymphadenectomy in 10 Steps

Study ObjectiveLaparoscopic transperitoneal lymphadenectomy has a few advantages. First, it is a minimally invasive approach, and the transperitoneal approach is also the best option when intra-abdominal surgery is indicated. Although the procedure was described more than 2 decades ago, there is a lack of diffusion of the technique. The main objective of this video is standardization and a simple description of the technique. We described this procedure in 10 logical steps, which should help to understand and perform this procedure. MethodsThis video presents a systematic approach to transperitoneal lumboaortic lymphadenectomy, which is clearly divided in 10 steps ordered in a counterclockwise direction. ResultsThe 10 steps are as follows: step 1, retroperitoneal access; step 2, creating a space for subsequent lymphadenectomy and identification of anatomic landmarks; step 3, left common iliac lymph node dissection; step 4, right common iliac lymph node dissection; step 5, presacral lymph node dissection; step 6, lateroaortal lymph node dissection; step 7, laterocaval lymph node dissection; step 8, aortocaval lymph node dissection; step 9, vaginal extraction of bags with specimens; and step 10, vaginal suture. ConclusionsLaparoscopic transperitoneal access to lumboaortic lymph nodes is an effective method of lymphadenectomy, which may bring benefits to a patient and physician. The presented 10 steps help to perform each part of surgery in a logical sequence, making the procedure ergonomic and easier to adopt and learn. Standardization of laparoscopic techniques could help to reduce the learning curve.