Improving double-docking for robot-assisted paraaortic lymphadenectomy in endometrial cancer staging: technique and surgical outcomes

Robot-assisted paraaortic lymphadenectomy (PALND) may prove to be a challenging procedure and the ability to reach planned anatomical landmarks is critical. In this retrospective study between 2012 and 2015, we present surgical data using a modified technique to perform infrarenal PALND for endometrial cancer using double side-docking.

All women with high-risk endometrial cancer scheduled for complete robotic staging including infrarenal PALND were included in the analysis. During the study period, a total of 76 women were identified. 3 patients had disseminated disease and treated with palliative hysterectomy only. The remaining 73 women underwent surgery with the intention to perform infrarenal PALND. In 7 cases, PALND was aborted due to technical inability to reach the left renal vein (10 %). A median of 36 lymph nodes were harvested (pelvic n=20, paraaortic n=16). Median operating time (skin-to-skin) for patients with completed infrarenal PALND was 228 min (range 181-371). Among all 76 patients, postoperative complications according to the Clavien-Dindo nomenclature were observed in 27 (36 %) patients, with 6 (8 %) having grade III complications. No patient died within 30 days from surgery. Our technique of double docking for robot-assisted PALND was associated with a success rate of 90 %. The described technique seems to be a useful strategy to maximize the likelihood of completing the planned procedure.

Journal of minimally invasive gynecology. 2016 Apr 07 [Epub ahead of print]

Linnea Ekdahl, Sahar Salehi, Henrik Falconer

Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden., Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden., Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. 

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