LAPAROSCOPIC PARAORTIC, PARACAVAL AND PELVIC RETROPERITONEAL LYMPH-ADENECTOMY / LINFADENECTOMIA RETRO-PERITONEAL PARAORTICA, PARACAVAL E PELVICA VIDEOLAPAROSCOPICA

M.E.P.B, female, 45 years, historic of severe endometriosis, was diagnosed at the intraoperative, after a biopsy of a suspect neoplasic lesion, with right ovarian adenocarcinoma associated with carcinomatosis. She was submited to a total histerectomy with bilateral ooforectomy, right ileocolectomy, shaving rectosigmoidectomy and posterior laparoscopic peritonectomy. After adjuvant chemoterapy, it has been seen compromise of the retroperitoneal lymph node chain. It was opted to a paraaortic and pelvic retroperitoneal laparoscopic lymphadenectomy, procedure showed at the video. Pacient under general anestesia, puted at Lloyd-Davies position. Bladder sounding, coupling perineal neuroestimulators at 4 and 8 hours. Trocars at habitual position, under direct visualisation. Performed the paracaval and paraaortic lymphadenectomy (not included at the vídeo) and de pelvic lynphadenectomy. Dissection of retroperitonela lymph node chains with bipolar ultrassonic tweezer, identifying the simpatic nervous plex, with bilateral ureterolis to protect the urinary tract. This report of operative technique make clear that the pelvic and paraortic lymphadenectomy, traditionally performed with open surgical because your complexity, it a factible, secure and eficient method when done by laparoscopic way. Although it requires a great operative hability for its execution, this technique, when performed by laparoscopic, can bring the benefits of a less invasive technique: reduction of the hospital internment, reduction of post-operative complications, better wound cicatrization, less operative bleeding, less chance os iatrogenic lesion and fewer infections rates.

Publication History

Article published online:
23 October 2019