LaparoscopIc para-aortIc lymphadenectomy Hüsnü ÇELİK, Professor, MD Başkent University, Medical School, Department of Obstetric and Gynecology, Division of Gynecologic Oncology (ADANA Campuse) 9/06/2018

Laparoscopic Lymphadenectomy Para-aortic Selective Systemic Transperitoneal Extraperitoneal Inframesenteric Infrarenal

Laparoscopic Lymphadenectomy Para-aortic Selective Systemic Transperitoneal Extraperitoneal Inframesenteric Infrarenal

Para-aortic Lymphadenectomy Whitney CW, 2010

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

Vascular anomalies in the paraaortic region Klemm P, 2015

Learning Curve Köhler C, 2004

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

Laparoscopic Lymphadenectomy 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

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

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 Many reports since have described the safety and effectiveness of laparoscopic lymphadenectomy for gynecologic and urologic malignancies, as well as for some lymphomas. Over recent years, there has been an expanding literature available regarding outcomes and complications of laparoscopic lymphadenectomy. Current reports, however, often reflect the developing skill set of the pioneering laparoscopists and the variable facility support for such advanced laparoscopic procedures. Also, in recurrence Huang K, 2016,

Video: Laparoscopic Transperitoneal para-aortic lymphadenectomy.

BMI n lymph nodes <20 (min: 14.8) 39 13.4 (1–32) 20.0–24.9 191 11.1 (1–42) 25.0–29.9 156 10.6 (1–52) >30 (max: 49.7) 79 9.9 (1–47)

Para-aortic Lymphadenectomy

Laparoscopic Lymphadenectomy   Many reports since have described the safety and effectiveness of laparoscopic lymphadenectomy for gynecologic and urologic malignancies, as well as for some lymphomas. Over recent years, there has been an expanding literature available regarding outcomes and complications of laparoscopic lymphadenectomy. Current reports, however, often reflect the developing skill set of the pioneering laparoscopists and the variable facility support for such advanced laparoscopic procedures. Also, in recurrence (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,

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

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