Pelvic lymph node dissection via a lateral extraperitoneal approach: Description of a technique

Objective: Locally advanced cervical cancers are generally managed by radiation and chemotherapy. Pretherapeutic laparoscopic assessment of aortic nodes in patients with locally advanced cervical cancer offers valuable information for individualized treatment planning with minimal morbidity when the extraperitoneal approach is used. Although the pioneers of the technique proposed to sample only the aortic and common iliac nodes, there is growing evidence that concomitant radiation and chemotherapy does not control all the diseased pelvic nodes. As a result, diseased but not fixed pelvic nodes amenable to an attempt at laparoscopic removal should be debulked during the staging surgery. The objective of this paper is to describe a new development of the extraperitoneal endosurgical approach. Methods: The left extraperitoneal approach routinely used for aortic and common iliac dissection has been extended to the pelvic area in eight patients. Results: The left pelvic dissection, including the removal of obturator nodes, has been successfully completed in all cases, including two patients with macroscopically diseased nodes. The right pelvic dissection has been successful in three out of four attempts. Conclusion: The lateral extraperitoneal route used for the routine staging in our institution can be extended to the pelvic area without additional transumbilical transperitoneal laparoscopy, thus reducing the adhesion formation in patients candidates for definitive radiation therapy.