Robotic transperitoneal aortic lymphadenectomy in gynecologic cancer: A new robotic surgical technique and review of the literature

Background. Lymph node status is a prognostic factor for gynecologic cancer. We describe a new developing strategy for robotic transperitoneal aortic lymphadenectomy without relocating the robotic column or the patient. Methods. Patients with histologically confirmed cervical cancer, early ovarian cancer, or endometrial carcinoma with suspected risk factors indicating aortic lymphadenectomy were eligible for the robotic transperitoneal aortic lymphadenectomy using the Da Vinci robotic system as part of the surgical treatment of gynecologic malignancies. Results. The mean operating time was 224 min (range 160-300 min), and the mean console time for aortic lymphadenectomy was 43 min (range 30-75). The median hemoglobin fall was 1.3 g/dL range (0.8-2 g/dL), the median number of removed aortic lymph nodes was 12.5 (range 7-17), and the median length of the hospital stay was 2 days (range 1-4 days). We experienced an intraoperative complication, but no conversion to laparotomy was necessary. No patients received a blood transfusion. Conclusions. This initial experience demonstrates the feasibility of robotic aortic lymphadenectomy with good accuracy and safety without relocating the robotic column or the patient.