title: Standardized technique of laparoscopic pelvic and para-aortic lymphadenectomy in gynecologic cancer optimizes the perioperative outcomes.
abstract: BACKGROUND
  The main objective of this study is to illustrate the effectiveness and the safety of standardized technique of laparoscopic lymphadenectomy (LNE), newly introduced in a University Hospital, in patients with gynecologic malignancy.
  
  
  METHODS
  A cohort of 104 patients with gynaecologic malignancies (71 with endometrial and 33 with cervical cancer), who underwent laparoscopic pelvic with or without para-aortic LNE between September 2008 and March 2010, were analyzed. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH & BSO) was the standard approach for patients with endometrial cancer (n = 71), while laparoscopic (nerve sparing) radical hysterectomy (n = 29), laparoscopic-assisted radical vaginal hysterectomy (n = 2) and radical trachelectomy was the treatment for patients with cervical cancer. All LNE were performed by a learning team under the supervision of an expert surgeon, familiar with the technique.
  
  
  RESULTS
  The median number of pelvic lymph nodes yielded was 22 (range 16-34) and of para-aortic 14 (range 12-24). The mean operative time ± standard deviation for pelvic LNE for each side was 29 ± 17 and 64 ± 29 min for para-aortic LNE. The overall complication rate was 7.6% (n = 8). Two patients were reoperated laparoscopically, one because of postoperative hemorrhage and the other because of lymphocyst formation; laparoconversion was not necessary.
  
  
  CONCLUSIONS
  Laparoscopic lymphadenectomy performed by a learning team with standardized technique is effective with adequate number of harvested nodes, in acceptable operative time and with low rate of perioperative complications.
authors.affiliation: Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. andreas.kavallaris@uk-sh.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Kavallaris
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kalogiannidis
authors.forename: Nektarios
authors.initials: N
authors.lastname: Chalvatzas
authors.forename: Amadeus
authors.initials: A
authors.lastname: Hornemann
authors.forename: Michael K
authors.initials: MK
authors.lastname: Bohlmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Diedrich
mesh_terms: D000328:Adult; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000592:standards; D010535:Laparoscopy / Q000379:methods* / Q000592:standards*; D008197:Lymph Node Excision / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D058994:Salpingectomy / Q000379:methods / Q000592:standards; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*