title: Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy as part of staging operation for early ovarian cancer and high grade endometrial cancer.
abstract: OBJECTIVE
  The aim of this paper was to demonstrate the techiniqes of single-port laparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgical staging procedure in case of early ovarian cancer and high grade endometrial cancer.
  
  
  METHODS
  After left upper traction of rectosigmoid, a peritoneal incision was made caudad to inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space of the lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliac nodes were easily removed due to the upward traction of the rectosigmoid. The superior hypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodes were removed at subaortic area. Peritoneal traction suture to right abdomen was needed for right para-aortic lymphadenectomy. After right lower para-aortic node dissection, operator was situated between the patient's legs. After upper traction of the small bowel, left upper para-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasure application (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes.
  
  
  RESULTS
  Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy was performed without serious perioperative complications.
  
  
  CONCLUSIONS
  Even though the technique of single-port surgery is still a difficult operation, the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissection is excellent, especially mean number of para-aortic nodes. In cases of staging procedures for ovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy is acceptable as an oncologic procedure.
authors.affiliation: Department of Obstetrics and Gynecology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea. yslee@knu.ac.kr.
authors.forename: Yoon Soon
authors.identifier: http://orcid.org/0000-0001-9013-9740
authors.initials: YS
authors.lastname: Lee
mesh_terms: D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D009367:Neoplasm Staging / Q000009:adverse effects / Q000379:methods; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000473:pathology*
keywords: Infrarenal Para-Aortic Lymphadenectomy; Single-Port; Transperitoneal