A NEW TRANSABDOMINAL APPROACH TO THE LEFT RETROPERITONEUM FOR SYSTEMATIC REMOVAL OF LYMPH-NODES LEFT OF THE AORTA IN GYNECOLOGIC MALIGNANCIES

To improve the exposure of the left retroperitoneum, a peritoneal inci sion is made in the left paracolic gutter up to the splenic flexure. B y elevating and medially displacing the left colon, the avascular plan e between this and the prerenal fascia is entered and developed caudal ly to the aorta bifurcation, and cranially 3-4 cm beyond the left rena l pedicle. Thus, the left kidney, its pedicle, the ureter, the ovarian vessels, and the aorta are adequately exposed. In 81 patients with gy necologic tumors who underwent the modified lymphadenectomy, the media n number of aortic nodes removed was 29 (range 21-56). The median dura tion of left dissection was 35 minutes (range 25-50) and of the entire aortic lymphadenectomy 70 minutes (range 50-120). No major intraopera tive injuries occurred. The frequency and type of postoperative compli cations were not affected by this modification. This new approach prov ides better exposure of the left retroperitoneum, thus permitting safe and complete dissection of the nodes left of the aorta without increa sed morbidity. If aortic dissection can be limited to the left side, t his technique makes it possible to avoid opening the right retroperito neum.