F. Lecuru et al., LAPAROSCOPIC PELVIC LYMPHADENECTOMY IN AN ANATOMICAL MODEL - RESULTS OF AN EXPERIMENTAL COMPARATIVE TRIAL, European journal of obstetrics, gynecology, and reproductive biology, 72(1), 1997, pp. 51-55
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.