PLACE OF COMPUTER-ASSISTED SURGERY IN THE EVALUATION OF LYMPH-NODE SPREAD IN PELVIC CANCERS - EXPLORATION BY RETROPERITONEOSCOPY

Extraperitoneal pelvioscopy is a surgical endoscopy without insufflati on which enables exploration of the extraperitoneal space in order to obtain biopsy specimens of adenopathies and tumors. 189 extraperitonea l endoscopy have been performed since 1976. When made through an iliac approach, the Extraperitoneal Endoscopy explores iliac and pelvic lym ph nodes. It is an indication when checking the extension of uterine, prostatic and bladder cancers. Recently, a system of computerized assi stance has been added To the initial method. Its aim is to guide the m ovements of the surgical tool when the indication is difficult: overwe ight patient, small tumors, risky tumoral environment. The basic princ iple is to show recalculated RMI or CT scan sections of the patient du ring the intervention on which appear in real time the positions of th e endoscope and that of Le target to biopsy. The authors describe the technical ways of the method the system of tridimensional localisation included hi the operating room and,he sort of interface given to the surgeon. In the future, the realisation of a simulator of intervention will allow diffusion and teaching of this intervention.