title: Robotic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy With Double Docking: Technique, Learning Curve, and Perioperative Outcomes.
abstract: Para-aortic lymphadenectomy (PAL) is a challenging procedure performed by minimally invasive surgery in very few centers, owing to its intrinsic technical complexity. We describe and assess the feasibility and learning curve of robotic double-docking transperitoneal infrarenal PAL combined with oncological pelvic surgery. Fifty patients who underwent this procedure using the Da Vinci S surgical system between March 2010 and May 2013 were included. The mean operating time for PAL surgery was 76 minutes (range, 32-150 minutes), and the mean number of lymph nodes per patient was 11.8 (range, 1-44). There were no conversions to laparotomy or laparoscopy. The mean length of hospital stay was 2 days (range, 1-25 days). Statistically significant decreases were noted for mean table rotation time (17 ± 6.8 minutes vs 13 ± 3.6 minutes; p = .02) and mean PAL operating time (85.4 ± 25.8 minutes vs 69.8 ± 24.6 minutes; p = .04) when comparing the first 20 patients and the last 30 patients. The number of nodes was similar in the first 20 patients and last 30 patients. The double-docking transperitoneal infrarenal PAL technique combined with oncological pelvic surgery is feasible, with minimal morbidity and a short learning curve.
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain. Electronic address: jponce@bellvitgehospital.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Ponce
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Barahona
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Pla
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rovira
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Garcia-Tejedor
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Gil-Ibanez
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain; Hospital Dr. Nélio Mendonça, Universidade da Madeira, Funchal, Portugal.
authors.forename: Hugo Manuel
authors.initials: HM
authors.lastname: Gaspar
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain; Consorci Sanitari Garraf, Hospital-Residència Sant Camil, Sant Pere de Ribes, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Sabria
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Bartolomé
authors.affiliation: Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Lola
authors.initials: L
authors.lastname: Marti
mesh_terms: D001012:Aorta, Abdominal / Q000601:surgery; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods; D059032:Learning Curve; D007902:Length of Stay; D008197:Lymph Node Excision / Q000193:education / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061646:Operative Time; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery; D010388:Pelvis / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000193:education / Q000379:methods*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Aortic lymphadenectomy; Gynecologic carcinoma; Robotic surgical procedures