Background We are reporting the preliminary multicentric experience in extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy (EPLRL) in gynecologic oncology. Materials and Methods Two teams from the cancer centers performed EPLRL in 37 patients with gynecologic cancer. Results There were 30 patients with cervical cancer, 6 with endometrial cancer, and 1 with adnexal cancer. The skin-to-skin operative time, mean lymph node count, and estimated blood loss were 221 (±61) minutes, 18.7 (±11), and 105 (±134) mL. There was no conversion to laparotomy, one laparoscopic conversion for hemorrhage lateral to the inferior mesenteric artery, and one use of hemostatic matrix for an injury to the left gonadal artery (2 nontransfused patients). The proportion of patients who reported postoperative complications was 32.5% (12/37): 7 with lymphocysts with computed tomographic scan drainage (19%), 3 with leg dysesthesia (left genitofemoral nerve), 1 with leg lymphedema, and 1 with lateral aortic hematoma not requiring a transfusion or return to the operating room. Conclusion The EPLRL technique is feasible and efficient but with a high rate of symptomatic lymphocyst. A marsupialization could be useful to decrease the risk of lymphocyst.

Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy in Gynecologic Oncology: Preliminary Experience and Advantages and Limitations

The idea that pelvic cancers can be treated by laparoscopy is now commonly admitted among gynaecological surgeons. Literature shows a lower morbidity than laparotomy, with similar prognostic results. Metastatic invasion of para-aortic lymph nodes is a major prognostic factor in gynaecological malignancies. It modifies the therapeutic plan and requires retroperitoneal lymphadenectomy in many indications. Laparoscopy is an interesting technical procedure in this situation: it allows both staging and curative surgery. Two laparoscopic ways are eligible: transperitoneal lymphadenectomy and retroperitoneal lymphadenectomy.

Voie d’abord cœlioscopique du curage lombo-aortique

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 5 - p. 473-480

Lymphadénectomie inter-iliaque per-cœlioscopique dans le cancer du col de l’utérus : toujours le gold standard ?

Le facteur pronostic majeur des cancers du col localement avances (LACC) est le statut ganglionnaire lombo-aortique. Notre travail de these a ete d'evaluer la lymphadenectomie lombo-aortique (qui represente la technique de reference pour obtenir cette information) a l'ere de la tomographie par emission de positron (TEP) et de la chirurgie par une seule incision (LESS). Les resultats publies de cette these sont: la lymphadenectomie lombo-aortique extraperitoneale par LESS est faisable. Nous en avons decrit et codifie la technique pour la premiere fois par une incision iliaque gauche unique ; cette technique que nous avons mise au point est sure, reproductible et equivalente sur le plan carcinologique et ergonomique a la laparoscopie conventionnelle ; la lymphadenectomie lombo-aortique de staging est indispensable dans les LACC compte tenu du taux de faux negatif du TEP-TDM retrouve dans ce travail de these (12% s'elevant a 22 % en cas de fixations ganglionnaires pelviennes suspectes). Nous avons egalement demontre sur la plus large de la serie de litterature que la lymphadenectomie lombo-aortique associee a l'extension des champs d'irradiation en lombo-aortique lors de la radio-chimiotherapie apporte aux patientes presentant des micrometastases une survie identique a celle des patientes negatives histologiquement au niveau lombo-aortique. En revanche, en cas d'atteinte macrometastatique le pronostic demeure pejoratif et necessite de proposer d'autres options therapeutiques

https://tel.archives-ouvertes.fr/tel-00880342/document

Lymphadénectomie lombo-aortique extrapéritonéale et single-port dans les cancers du col localement avancés : faisabilité, reproductibilité, aspects ergonomiques et intérêt en termes de survie à l'ère de la tomographie par émission de positron (TEP) couplé au scanner (TDM)

Introduction: Extraovarian granulosa cell tumor (GCT) is a very uncommon tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. Case report: We report the case of a 25 year-old woman who was presented at the emergency unit with a severe abdominal pain focused on the left iliac fossa. The patient had delivered normally 2 months before. An ovarian mass of 79 × 67 × 89 mm was shown in vaginal ultrasound as well as at the abdominal scan. Exploratory laparoscopy was performed and a torsion of the fallopian tube and an hemato-salpinges was visualized. Re-vascularisation was not achieved and a left salpingectomy took place. The immuno-histopathology report revealed an extra-ovarian GCT deriving from the fimbriae of the tube. Follow-up surgery was discussed. The case is presented for its rarity.

/pdf/atypical-presentation-and-localization-of-granulosa-cell-3hfljj5pwd.pdf

Atypical presentation and localization of granulosa cell tumor—A case report and review of the literature

[Celioscopic pelvic and para-aortic lymphadenectomy].

La lymphadénectomie percœlioscopique

Les tumeurs de la granulosa sont des tumeurs relativement rares de l'ovaire. Leur incidence annuelle est d'environ 0,9 pour 100 000 femmes. Nous rapportons le cas original de tumeur de la granulosa, decouverte chez une femme de 25 ans, au cours du premier trimestre de sa quatrieme grossesse. Originale car cette tumeur est incluse dans le ligament large avec ovaires normaux. Le traitement chirurgical a consiste en une exerese complete de la tumeur associee a une annexectomie homolaterale par necessite technique. A l'occasion de ce travail, sont revus l'embryologie, l'aspect clinique et paraclinique, le traitement et le pronostic de ces tumeurs.

[Granulosa cell tumors: a case located in the broad ligament of the uterus with normal ovaries].

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[Celioscopic pelvic and para-aortic lymphadenectomy].

La lymphadénectomie percœlioscopique

[Granulosa cell tumors: a case located in the broad ligament of the uterus with normal ovaries].