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Rectal mobilization for laparoscopic pelvic lymphadenectomy of the lower paracervical pathway in patients with uterine cancer

Obstetrics & Gynecology Science 2021년 64권 6호 p.555 ~ 559
Kisu Iori, Nomura Hidetaka, Iida Miho, Banno Kouji, Shiraishi Tetsuro, Iijima Moito, Nakamura Kayoko, Matsuda Kiyoko, Hirao Nobumaru,
소속 상세정보
 ( Kisu Iori ) - Tachikawa Hospital Department of Obstetrics and Gynecology
 ( Nomura Hidetaka ) - Cancer Institute Hospital Department of Gynecologic Oncology
 ( Iida Miho ) - Keio University School of Medicine Department of Obstetrics and Gynecology
 ( Banno Kouji ) - Keio University School of Medicine Department of Obstetrics and Gynecology
 ( Shiraishi Tetsuro ) - Tachikawa Hospital Department of Obstetrics and Gynecology
 ( Iijima Moito ) - Tachikawa Hospital Department of Obstetrics and Gynecology
 ( Nakamura Kayoko ) - Tachikawa Hospital Department of Obstetrics and Gynecology
 ( Matsuda Kiyoko ) - Tachikawa Hospital Department of Obstetrics and Gynecology
 ( Hirao Nobumaru ) - Tachikawa Hospital Department of Obstetrics and Gynecology

Abstract


Objective: The pelvic lymphatic drainage system comprises the upper and lower paracervical pathways (LPPs). Lymph node dissection of the LPP, including the cardinal ligament, internal iliac, internal common iliac, and presacral lymph nodes, requires higher surgical skills because of the anatomical limitations of the pelvic cavity and the dissection of vessels while preserving the nerves in the pelvic floor. In this video, we demonstrate rectal mobilization for laparoscopic complete pelvic lymph node dissection of the LPP in patients with uterine cancer.

Methods: Rectal mobilization was performed before complete pelvic lymph node dissection of the LPP. The pararectal space was opened widely and the connective tissue between the presacral fascia and prehypogastric nerve fascia was dissected bilaterally, allowing the rectum to be pulled.

Results: This procedure created a wide-open space in the pelvic floor, allowing clear visualization of the nerves and lymph nodes of the LPP. Laparoscopic complete lymph node dissection of the LPP was performed in the open space while preserving the hypogastric and pelvic splanchnic nerves and isolating the extensive network of blood vessels in the pelvic cavity.

Conclusion: Rectal mobilization enabled the safe execution of laparoscopic complete pelvic lymph node dissection of the LPP in patients with uterine cancer.

키워드

Cervical cancer; Laparoscopic surgery; Pelvic lymphatic pathway; Uterine cancer

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