Extraperitoneal Endoscopic Total Retroperitoneal Lymphadenectomy-No Bowel Surgery

We describe our ultra-minimally invasive retroperitoneal lymphadenectomy using the extraperitoneal approach. This technique was developed to make traditionally invasive oncologic surgery more patient friendly and safer by eliminating the bowel from the operative field.Description of a surgical technique.We access the retroperitoneal space with a visual access cannula (Endotip). This device easily facilitates peritoneal tenting. After expanding the extraperitoneal space by blunt dissection with forceps, carbon dioxide is infused. The upper limit of our dissection is the renal vein and the lower limit is the iliac circumflex vein. The extraperitoneal approach naturally creates a bowel-free operative field, even when dissecting in the pelvis. This approach only requires a 5mm access hole making it the least invasive approach to this kind of surgery.Patients underwent endoscopic extraperitoneal paraaortic and pelvic lymphadenectomy for endometrial cancer.We can achieve a total paraaortic and pelvic retroperitoneal dissection with this extraperitoneal approach without the bowel invading the operative field. This procedure is focused on the barrier-free nature of working in the retroperitoneal space; meaning, a space which is not hindered by the invasion of the bowel or other intraperitoneal structures. The five-year survival rates for this intervention combined with hysterectomy and bilateral adnexectomy are extremely favorable at 90% for patients with stage I to III disease, making this technique a viable minimally invasive approach for selected patients.