Staging Endometrial Cancer

Jean-Marie Stephan, MD, Megan McDonald, MD, Jean Hansen, DO, Michael J. Goodheart, MDDepartment of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA (all authors).ABSTRACT

Introduction: We report a novel technique for the vaginal placement of a single-incision laparoscopic device to aid in the removal of pelvic and para-aortic lymph nodes in patients undergoing gynecologic cancer surgery.

Technique Description: Informed consent for laparoendoscopic single-site total hysterectomy and bilateral salpingooophorectomy with pelvic and para-aortic lymph node dissection was obtained. A single-incision laparoscopic device was placed through a 2.5-cm umbilical incision, and a total laparoscopic hysterectomy with removal of the ovaries and tubes was performed. Preoperative pathologic analysis showed a grade 2 endometrioid adenocarcinoma of the endometrium, and as a result, bilateral pelvic and para-aortic lymph node dissection was completed. To aid in the lymphadenectomy, an additional transvaginal single-incision laparoscopic device was placed. The procedure was completed in 221 minutes, with 125 minutes spent on the pelvic and para-aortic lymph node dissection. There were no intraoperative or postoperative complications. The amount of blood loss was 50 mL. There were 10 pelvic lymph nodes and 5 para-aortic lymph nodes removed, with no carcinoma detected. The patient tolerated the procedure well and was discharged home the next day.

Discussion: Placement of a second transvaginal port is a feasible technique that provides great flexibility and assistance for lymph node removal in gynecologic cancer surgery.

Key Words: Endometrial cancer, Laparoscopic surgery, Lymph node dissection, Laparoendoscopic single-site surgery.

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