Laparoscopic pelvic and aortic lymphadenectomy.
A systematic approach to the laparoscopic management of gynaecological malignancies began about 5 years ago more or less simultaneously in a few centres in France and the USA. Mature data and long-term follow-up are not yet available. Despite the absence of comparative studies, evidence is, in this author's opinion, now compelling that pelvic and aortic lymphadenectomy can be carried out just as effectively laparoscopically as via a laparotomy. This conclusion is based on traditional surgical, anatomical and pathological considerations such as the way in which the operation is executed, photodocumentation of the extensiveness of the dissection, the lymph node harvest and the proportion of positive lymph nodes recovered. The benefits of a laparoscopic approach have yet to be demonstrated in comparative studies, but compared with historical controls, the reduction in morbidity is so dramatic as to leave little doubt that patients benefit from laparoscopic treatment in experienced hands.
Kadar
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Gynecologic Oncology, New Margaret Hague Women's Health Institute, Meadowlands Hospital and Medical Center, Secaucus, NJ 07094, USA.
D001011:Aorta; D016889:Endometrial Neoplasms / Q000601:surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery; D010388:Pelvis