Laparoscopic bilateral pelvic and paraaortic lymph node sampling: an evolving technique.

Abstract

Reports describing laparoscopic lymph node sampling in patients with gynecologic malignancies have yet to describe a method to sample left-sided aortic lymph nodes that has been successful in a large series of patients. We submit our experience with evolving techniques that allow for excellent visualization and resection of both left and right aortic and pelvic lymph nodes. Forty patients with gynecologic malignancies underwent laparoscopy for surgical staging. Thirty-five of the patients were completely staged laparoscopically with minimal blood loss. The average number of lymph nodes sampled was 27.7 (range 14 to 35). Five patients required laparotomy, two to control bleeding, two to remove unsuspected intraabdominal disease, and one because of equipment failure. Four patients were rehospitalized within 30 days of surgery, two with small bowel obstructions resulting from herniation of the intestine through 12 mm trocar sites and two others with deep vein thromboses. These preliminary results demonstrate an ability to complete surgical staging in patients with gynecologic malignancies by means of specific endoscopic techniques. However, there remains a need for continued evaluation of these techniques and the associated morbidities.