In gynecologic oncology lymphadenectomy is of prognostic and
therapeutic importance because recurrence-free time and survival
depend on the metastatic involvement of lymph nodes.
Lymphadenectomies are not performed to such an extent as they are
indicated. This might be due to a laborious or problematic
preparation. The authors therefore report their experience in a
seldom taught preparation of the left para-aortic compartment in
the form of a learning curve.
MATERIALS AND METHODS: To access the left para-aortic area, the
descending colon is lifted to open the retroperitoneum along the
line of Toldt. The mesentery of the descending colon was separated
from the kidney along the fascia of Gerota by blunt preparation.
Time was measured from the incision of the peritoneum until the
renal vein was clearly visible.
RESULTS: The authors collected the data from the first 25
preparations. Mean duration for the left para-aortic preparation
was 7.8 minutes compared to 5.9 minutes for the right side.
Duration of preparation of the left area dropped from 11.0 minutes
within the first patients (#1 to #5) to 3.8 minutes in the last
patients (#20 to #25). No complications were observed in the study
group linked to the retromesenteric approach described.
CONCLUSION: Retromesenteric para-aortic lymphadenectomy is quick to
learn. The authors needed 20 preparations to observe a significant
drop in the time needed for preparation. Retromesenteric
para-aortic lymphadenectomy offers an excellent overview that
lightens lymphadenectomy and therefore reduces the risks for
PMID: 23327048 [PubMed – indexed for MEDLINE]