Transperitoneal laparoscopic pelvic lymphadenectomy for gynecologic malignancies (I) : Technique and results

We reviewed the published experimental and clinical data, available in MEDLINE, and compared them to our experience in a university-affiliated tertiary medical center of obstetrics and gynecology in order to describe the accepted techniques and results of laparoscopic pelvic lymphadenectomy. The procedure requires a four-port access laparoscopy. Dissection boundaries are similar to those for open surgery. Experimental and clinical comparative series have shown that the number of harvested lymph nodes is not significantly different for laparoscopy than for laparotomy. Several authors reported a learning curve, reflecting the surgeon's increasing accuracy with growing operative experience. Obesity and prior history of laparotomy are both factors that impact adversely on the number of nodes harvested and the complication rate. Otherwise, the number of residual nodes is similar 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 laparoscopic operators. It is similar to that reported for open surgery. Anesthesiological complications have not been well assessed in the literature on laparoscopic lymphadenectomy. Operating time was longer than for laparotomy in all the series. Conversely, mean blood loss, duration of hospitalization, and recovery time were significantly decreased. Although intraoperative cost of the laparoscopic procedure is high in comparison with laparotomy, since the time of recovery appears shorter, total costs may be similar or even lower. We conclude that laparoscopic pelvic lymphadenectomy is a reliable and safe procedure for the evaluation and treatment of gynecologic cancers.