title: Comprehensive Staging of Uterine Carcinosarcoma Using a Multiquadrant Robotic Platform.
abstract: To demonstrate the feasibility of multiquadrant staging of a uterine carcinosarcoma using the latest-generation robotic platform.
  
  
  
  Step-by-step explanation of the technique using videos and pictures (educative video).
  
  
  
  Although laparoscopic and robotic-assisted laparoscopic staging of high-risk uterine cancer is well incorporated into many gynecologic oncology practices, extensive para-aortic lymphadenectomies above the inferior mesenteric artery are less commonly performed. Additionally, infracolic omentectomies are frequently performed in lieu of infragastric omentectomies.
  
  
  
  A 67-year-old woman with a newly diagnosed uterine carcinosarcoma.
  
  
  
  Multiquadrant comprehensive staging of uterine carcinosarcoma using the latest-generation robotic platform.
  
  
  
  We demonstrate in this video a facile approach for robotic surgeons to perform an extensive para-aortic lymphadenectomy up to the renal vessels, as well an infragastric omentectomy, using the latest-generation multiquadrant robotic platform. This platform allows for facile rotation from an upper abdominal view to perform the para-aortic lymphadenectomy and omentectomy, to a pelvic view to complete the pelvic lymphadenectomies, hysterectomy and bilateral salpingo-oophorectomy. We demonstrate this technique in a 67-year-old woman with a newly diagnosed uterine carcinosarcoma who underwent a robotic-assisted laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy, and infragastric omentectomy via the Xi Da Vinci Robot (Intuitive Surgical, Sunnyvale, CA). Total operative time was 280 minutes (50 minutes for the omentectomy, 86 minutes for the para-aortic lymphadenectomy). Estimated blood loss was 50 mL. Final pathology revealed a stage IA uterine carcinosarcoma; a total of 27 para-aortic lymph nodes and 20 pelvic lymph nodes were removed, and the size of the excised omentum was 68 × 10 × 1.2 cm.
  
  
  
  The technique of using alternating dual perspectives (upper abdominal or pelvic views) through a multiquadrant robotic platform enables the robotic surgeon to perform extensive para-aortic lymphadenectomies and omentectomies without resorting to laparoscopic surgery to complete these procedures.
authors: Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California. Electronic address: tdellinger@coh.org.
authors: Thanh H
authors: TH
authors: Dellinger
authors: Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors: Mark T
authors: MT
authors: Wakabayashi
authors: Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors: Ernest S
authors: ES
authors: Han
mesh_terms: D000368:Aged; D002296:Carcinosarcoma / Q000473:pathology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000379:methods*; D014594:Uterine Neoplasms / Q000473:pathology*
keywords: Infragastric omentectomy; Infrarenal para-aortic lymphadenectomy; Multiquadrant robotic staging; Uterine carcinosarcoma