title: Robotic retroperitoneal lower para-aortic lymphadenectomy in cervical carcinoma: first report on the technique used in 5 patients.
abstract: OBJECTIVE
  Retroperitoneal para-aortic laparoscopic lymphadenectomy is a technically challenging operation. The robotic Da Vinci system might be valuable in this operation due to a steady three-dimensional visualization, instrumentation with articulating tips, and an adaptive downscaling of the surgeons movements (without tremor). To the best of our knowledge, this is the first report on robotic retroperitoneal para-aortic lymphadenectomy in patients with gynecologic cancer.
  
  
  RESULTS
  We report on the technique and operative results of the robotic retroperitoneal lower para-aortic lymphadenectomy using the Da Vinci Surgical System. Five patients with cervical carcinoma stage IIb-IIb were included. Technically the procedure was easier to perform than with the classical retroperitoneal laparoscopic approach. However using the Da Vinci Surgical System it is important to tilt the patient slightly to the left to avoid collision between the left arm of the patient and the robotic arms, and to place the endoscopic robotic arm between the 2 arms used for dissection. Finally, we experienced that using a 30 degrees scope is advantageous for the dissection of the paracaval nodes. None of the patients had evidence of para-aortic metastases on preoperatively staging, including Positron Emission Tomography - Computed Tomography (PET-CT). One of the patients had positive para-aortic lymph nodes.
  
  
  CONCLUSIONS
  Here we report on the surgical technique used in our first 5 patients undergoing retroperitoneal para-aortic lymphadenectomy using the robotic Da Vinci system. It is important to adapt the surgical technique using the Da Vinci Surgical System compared with the classical laparoscopic technique.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium. Ignace.Vergote@uzleuven.be
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Bram
authors.initials: B
authors.lastname: Pouseele
authors.forename: Toon
authors.initials: T
authors.lastname: Van Gorp
authors.forename: Bernard
authors.initials: B
authors.lastname: Vanacker
authors.forename: Karin
authors.initials: K
authors.lastname: Leunen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cadron
authors.forename: Patrick
authors.initials: P
authors.lastname: Neven
authors.forename: Frederic
authors.initials: F
authors.lastname: Amant
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D012187:Retroperitoneal Space; D012371:Robotics; D002583:Uterine Cervical Neoplasms / Q000473:pathology*