1. 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

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

8. Learning Curve
Köhler C, 2004

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

10. 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

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

12. 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,

13. Video: Laparoscopic Transperitoneal para-aortic lymphadenectomy.

14. 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)

15. Para-aortic Lymphadenectomy

16. 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,

17. 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

18. 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