PRELIMINARY TECHNIQUE OF LAPAROSCOPIC EXTRAPERITONEAL INFRARENAL PARAAORTIC LYMPHADENECTOMY IN THE PORCINE MODEL

We developed an extraperitoneal approach to laparoscopic infrarenal pa raaortic lymphadenectomy in the porcine model, with the ultimate aim o f shortening the long learning curve of this procedure in humans. Surg ery was performed on lour females pigs with three IO-mm cannulas place d along the midaxillary line in prone position. The first and second p igs underwent subsequent laparotomy to evaluate the adequacy oi lymph node dissection and complications. In all four animals, complete infra renal paraaortic lymphadenectomy was successful, retrieving between 6 and 11 lymph nodes (average 9). Laparotomy in the first two animals co nfirmed adequate lymphadenectomy. No complications occurred. Operating lime was shortened dramatically with each procedure (180, 720, 50, 40 min). In the porcine model this approach provides excellent exposure to the entire paraaortic lymphatic chain, is sale, and has a remarkabl y short learning curve. Development of a similar technique in humans m ay have significant advantages, including short learning curve, feasib ility in obese patients and those with peritoneal adhesions, decreased adhesion formation, and reduced bowel complications associated with p ostoperative adjuvant irradiation. Further studies are indicated.