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        Robot-assisted extraperitoneal para aortic lymphadenectomy (RAePAL) performed with the bipolar cutting method

        Shiori Yanai,Kiyoshi Kanno,Kiyoshi Aiko,Masaaki Andou 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1

        Objective: In comparison with laparoscopic transperitoneal para-aortic lymphadenectomy,the advantages of laparoscopic extraperitoneal para-aortic lymphadenectomy (ePAL) arethat the operative field is not obstructed by bowel and the Trendelenburg position is notrequired [1]. The ePAL technique has been adopted to the robotic surgery with the da VinciXi. There are only a few reports demonstrating the technical feasibility of robot-assisted ePAL(RAePAL) [2,3]. This report describes the new surgical technique of RAePAL with the bipolarcutting method. Methods: The patient was a 53-year-old woman diagnosed as ovarian clear cell carcinoma(CCC) after left salpingo-oophorectomy. As the re-staging surgery, robot-assisted rightsalpingo-oophorectomy, hysterectomy, omentectomy, and pelvic lymphadenectomy wereplanned following ePAL. The patient was placed in the supine position and tilted 5 degrees tothe right. Three da Vinci arms were docked at the patient's left side (Fig. 1). The bipolar cuttingmethod was performed by with the surgeon's right hand. An AirSeal® port (ConMed, Utica,NY, USA) was placed on the side near the assistant. After the para-aortic space was expanded,lymphadenectomy was performed up to the renal veins with the bipolar cutting method. Results: The PAL operative time was 155 minutes, estimated blood loss was 25 mL. Thepatient developed no perioperative complications, and the postoperative diagnosis was stageIC1 ovarian CCC with no pelvic (n=0/42) and para-aortic lymph nodes (n=0/59) metastasis. Conclusion: RAePAL with the bipolar cutting method was technically feasible. Performinglymphadenectomy between the aorta and the vena cava was facilitated by the articulatedrobotic arm.

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