title: Robotically assisted laparoscopy for paraaortic lymphadenectomy: technical description and results of an initial experience.
abstract: OBJECTIVE
  The objective of this study is to demonstrate the feasibility of robotically assisted laparoscopy paraaortic lymphadenectomy (PAL), isolated or combined with another procedure using different surgical approaches.
  
  
  METHODS
  From February 2007 to December 2010, 53 patients underwent paraaortic lymphadenectomy up to the left renal vein. We used three different approaches with three different positions for the robot in relation to the surgical procedure (isolated transperitoneal PAL, isolated extraperitoneal PAL, or transperitoneal PAL combined with another procedure). Thirty-nine patients underwent isolated lomboaortic lymphadenectomy and 14 a combined procedure. Information concerning installation time, operative time, peri- and postoperative complications, blood loss, lymph node count, and conversion rate was recorded.
  
  
  RESULTS
  For the whole population, mean installation time was 33 ± 18 min, mean operative time was 197 ± 81 min, and mean hospital stay was 3.9 ± 2.8 days. We observed 15.1% lymph node involvement at definitive pathology. Between isolated trans- and extraperitoneal PAL, only body mass index (BMI, 27.4 versus 22 kg/m(2)) was significantly different. No difference was observed concerning mean number of lymph nodes or hospital stay. We observed statistical difference between combined and isolated PAL concerning mean operative time (256 versus 160 min), mean number of lymph nodes (7.8 versus 14.6), and hospital stay (5.9 versus 2.9 days).
  
  
  CONCLUSIONS
  Although laparoscopic robotic-assisted PAL is a safe and feasible procedure, lymph node staging seems to be better if the procedure is isolated. In case of combined procedures, the surgical approach should be modified regarding patient BMI and the associated procedure, to increase lymph node count.
authors.affiliation: Department of Surgery, Paoli Calmettes Institute, 232 Bd Sainte Marguerite, 13009 Marseille, France. lambaudie@marseille.fnclcc.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Lambaudie
authors.forename: Fabrice
authors.initials: F
authors.lastname: Narducci
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.forename: Marie
authors.initials: M
authors.lastname: Bannier
authors.forename: Camille
authors.initials: C
authors.lastname: Jauffret
authors.forename: Francesco
authors.initials: F
authors.lastname: Cannone
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics