title: Robotic extraperitoneal paraaortic lymphadenectomy in gynecological cancers: feasibility, safety, and short-term outcomes of isolated and combined procedures.
abstract: OBJECTIVE
  The aim of our study was to report the technique, the feasibility, and perioperative results of robotic extraperitoneal paraaortic lymphadenectomy in gynecological cancers performed for isolated or combined procedures.
  
  
  METHODS
  This is a retrospective study of 24 consecutive patients undergoing robotic extraperitoneal paraaortic lymphadenectomy using the Da Vinci Surgical system (Intuitive Inc, Sunnyvale, CA) (cervical cancer, n = 15; high-risk endometrial cancer, n = 8; and ovarian cancer, n = 2, including 1 synchronous tumor). Extraperitoneal paraaortic lymphadenectomy was performed using the surgical technique previously described by laparoscopy.
  
  
  RESULTS
  Of the 24 included patients, 12 patients had isolated robotic extraperitoneal paraaortic lymphadenectomy, whereas the others underwent the following associated procedures: total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy (n = 7); pelvic transperitoneal lymphadenectomy (n = 3), laparotomic Bricker procedure (n = 1), and colpectomy (n = 1). The median age of patients was 55 (42-64) years, and body mass index was 24.1 kg/m (20.9-26.1). The operation was completed in all patients except three with associated procedures. Perioperative difficulties were encountered in 9 patients (gas leakage, n = 7; adhesions, n = 2; and dissection difficulties, n = 1). The number of removed paraaortic lymph nodes was 18 (14-25). The operating times were 180 (150-210) minutes for isolated extraperitoneal paraaortic lymphadenectomy and 240 (180-300) minutes in case of associated procedures. There were 2 intraoperative (pneumothorax and renal artery injury) and 5 postoperative (3 grades 1-2 and 2 grade 3) complications.
  
  
  CONCLUSIONS
  If robotic-assisted extraperitoneal paraaortic lymphadenectomy seems feasible in case of isolated procedure, further studies are required to prove its benefit compared with conventional laparoscopy.
authors.affiliation: *Faculté de Médecine, Université Paris Descartes; †Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou; and ‡INSERM UMR-S 747, Université Paris Descartes, Paris, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Bats
authors.forename: Myriam
authors.initials: M
authors.lastname: Mimouni
authors.forename: Chérazade
authors.initials: C
authors.lastname: Bensaïd
authors.forename: Julien
authors.initials: J
authors.lastname: Seror
authors.forename: Nathalie
authors.initials: N
authors.lastname: Douay-Hauser
authors.forename: Claude
authors.initials: C
authors.lastname: Nos
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lécuru
mesh_terms: D000328:Adult; D001011:Aorta; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D010529:Peritoneal Cavity; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D016896:Treatment Outcome