LAPAROSCOPIC PELVIC LYMPHADENECTOMY IN AN ANATOMICAL MODEL - RESULTS OF AN EXPERIMENTAL COMPARATIVE TRIAL

Objectives: The aim of this paper was to compare the accuracy of lapar oscopic versus open pelvic lymphadenectomy in an experimental trial. S tudy design: We performed unilateral laparoscopic pelvic lymphadenecto mies (LPL) in 33 non-embalmed cadavers between the external iliac vein , the obliterated umbilical artery and the obturator nerve. Then a lap arotomy was performed to inspect the LPL limits, look for laparoscopic complications and finally realize a controlateral lymphadenectomy. Th e LPL side was randomly decided. A pathologist counted the number of l ymph nodes collected with both techniques. We compared the number of r etrieved lymph nodes, the completeness of the dissection and the compl ication rate with those two procedures. Student's t-test, chi(2)-test and non-parametric tests were used when appropriate. Results: No disse ction had to be aborted. One hundred and twelve nodes were removed lap aroscopically (mean, 3.73; S.E., 2.9) and 84 at laparotomy (mean, 2.77 ; S.E., 2.06). There was no significant difference in the number of no des retrieved with both procedures. Effectiveness of laparoscopy was n ot significantly different in the first ten procedures, in the second ten or in the last ten LPL. Residual tissue was observed after LPL in 13.3% of the procedures whereas all open lymphadenectomies were comple te. LPL sensitivity reached at least 86%, in this paper. Failures were more frequent al the beginning of the study (50% among the first ten dissections), in obese subjects or in subjects with prior history of l aparotomy (but the difference was not significant). Two venous injurie s occurred during LPL (6.7%). Complication rates for the two technique s were not significantly different. However, the LPL complication rate was higher al the beginning of the study and increased significantly in subjects with prior history of laparotomy (P < 0.05). Conclusions: This randomized study shows that LPL and laparotomy have similar effec tiveness. Incomplete dissections and complications are more frequent i n obese subjects or in case of prior history of laparotomy. Fifteen pr ocedures seems necessary to learn the technique and provide constant a nd safe results in routine practice. (C) 1997 Elsevier Science Ireland Ltd.