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LaparoscopIc para-aortIc lymphadenectomy

LaparoscopIc para-aortIc lymphadenectomy. Hüsnü ÇELİK, Professor , MD Başkent University , Medical School , Department of Obstetric and Gynecology , Division of Gynecologic Oncology (ADANA Campuse ). Laparoscopic Lymphadenectomy. Para-aortic Selective Systemic Transperitoneal

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LaparoscopIc para-aortIc lymphadenectomy

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  1. LaparoscopIc para-aortIclymphadenectomy Hüsnü ÇELİK, Professor, MD Başkent University, MedicalSchool, Department of ObstetricandGynecology, Division of GynecologicOncology (ADANA Campuse)

  2. Laparoscopic Lymphadenectomy • Para-aortic • Selective • Systemic • Transperitoneal • Extraperitoneal • Inframesenteric • Infrarenal

  3. Laparoscopic Lymphadenectomy • Para-aortic • Selective • Systemic • Transperitoneal • Extraperitoneal • Inframesenteric • Infrarenal

  4. Para-aortic Lymphadenectomy Whitney CW, 2010

  5. Laparoscopic Transperitoneal para-aortic lymphadenectomy. • Knowledge of the retroperitoneal anatomy • Vessels, ureter, neural, Lymhatics, potantial spaces, anomalies (30%).. • Surgical ability • Learning curve • Oncologic Meaning

  6. Vascular anomalies in the paraaortic region Klemm P, 2015

  7. Learning Curve Köhler C, 2004

  8. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging Mariani A, Gynecol Oncol. 2008 

  9. The Role of Para-Aortic Lymphadenectomy in the Surgical Staging of Women with Intermediate and High-Risk Endometrial Adenocarcinomas Laparoscopic Lymphadenectomy • Patients in the PPALN group who had less than 10 para-aortic nodes removed were twice as likely to recur than patients who had 10 or more para-aortic nodes or patients in the PLN group • If systematic para-aortic lymphadenectomy is performed and less than 10 para-aortic lymph nodes are obtained, multimodality adjuvant therapy should be considered to improve DFS. May , 2013

  10. Systematic pelvic and aortic lymphadenectomy in intermediate and high-risk endometrial cancer: Mariani A, 2008

  11. Laparoscopic Lymphadenectomy Trocar placements for transperitoneal para-aortic lymphadenectomy. Step1:Peritoneal incision. Step2: Peritoneal elevation and fixation Step3: Anterior dissection ,Major vascular anatomy, hypogastric nerve Step4:Lymphatic tissue dissection Huang K, 2016,

  12. Video: Laparoscopic Transperitoneal para-aortic lymphadenectomy.

  13. Para-aortic Lymphadenectomy

  14. Laparoscopic Lymphadenectomy (A, B) Trocar placements for transperitoneal para-aortic lymphadenectomy. (C) Trocar placement for extraperitoneal para-aortic lymphadenectomy Huang K,Gynecology and Minimally Invasive Therapy, 2016,

  15. Fig. 4. Distribution of postoperative complications between 1994 and 2003. Christhardt Köhler, Petra Klemm, Anja Schau, Marc Possover, Norman Krause, Roberto Tozzi, Achim Schneider Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies Gynecologic Oncology, Volume 95, Issue 1, 2004, 52–61 http://dx.doi.org/10.1016/j.ygyno.2004.07.025

  16. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging 281 patients lymphadenectomy. 22%lymph node metastases 77% of patients with para-aortic node involvement had metastases above the IMA, 7 patients (28%) had documented metastatic involvement of gonadal veins or surrounding soft tissue. Mariani A, 2008

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