TRANSPERITONEAL LAPAROSCOPIC PELVIC LYMPHADENECTOMY FOR GYNECOLOGIC MALIGNANCIES (I) - TECHNIQUE AND RESULTS

Background: We reviewed the published experimental and clinical data, available in MEDLINE, and compared them to our experience in a univers ity-affiliated tertiary medical center of obstetrics and gynecology in order to describe the accepted techniques and results of laparoscopic pelvic lymphadenectomy. Methods: The procedure requires a four-port a ccess laparoscopy. Dissection boundaries are similar to those for open surgery. Results: Experimental and clinical comparative series have s hown that the number of harvested lymph nodes is not significantly dif ferent for laparoscopy than for laparotomy. Several authors reported a learning curve, reflecting the surgeon's increasing accuracy with gro wing operative experience. Obesity and prior history of laparotomy are both factors that impact adversely on the number of nodes harvested a nd the complication rate. Otherwise, the number of residual nodes is s imilar for the two approaches. In both cases, it is low, resulting in a high sensitivity (95-100%). The complication rate is directly linked to the surgeon's experience and thus appears low for skilled laparosc opic operators. It is similar to that reported for open surgery. Anest hesiological complications have not been well assessed in the literatu re on laparoscopic lymphadenectomy. Operating time was longer than for laparotomy in all the series. Conversely, mean blood loss, duration o f hospitalization, and recovery time were significantly decreased. Alt hough intraoperative cost of the laparoscopic procedure is high in com parison with laparotomy, since the time of recovery appears shorter, t otal costs may be similar or even lower. Conclusion: We conclude that laparoscopic pelvic lymphadenectomy is a reliable and safe procedure f or the evaluation and treatment of gynecologic cancers.