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.