Data_Sheet_1_The Transumbilical Laparoendoscopic Single-Site Extraperitoneal Approach for Pelvic and Para-Aortic Lymphadenectomy: A Technique Note and Feasibility Study.PDF

BackgroundNowadays, lymphadenectomy could be performed by the transperitoneal or extraperitoneal approach. Nevertheless, each approach has its own advantages and disadvantages. Under these circumstances, we developed a transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy. In this research, the primary goal is to demonstrate the feasibility of the novel approach in systematic lymphadenectomy and present the surgical process step-by-step.
MethodsBetween May 2020 and June 2021, patients who had the indications of systematic lymphadenectomy underwent lymphadenectomy via the TU-LESS extraperitoneal approach. This new approach was described in detail, and the clinical characteristics and surgical outcomes were collected and analyzed.
ResultsEight patients with gynecological carcinoma were included in the research, including four with high-risk endometrial cancer and four with early-stage ovarian cancer. The TU-LESS extraperitoneal approach for pelvic and para-aortic lymphadenectomy was successfully performed in all patients without conversion. In all, a median of 26.5 pelvic lymph nodes (range 18–35) and 18.0 para-aortic lymph nodes (range 7–43) were retrieved. There was a median of 166.5 min of surgical time (range 123–205). Patients had speedy recoveries without complications. All patients had positive pain responses after surgery, as well as satisfactory cosmetic and body image outcomes.
ConclusionOur initial experience showed that it is feasible to perform systematic lymphadenectomy with the TU-LESS extraperitoneal approach. And this new approach may provide a new measure or a beneficial supplement for lymphadenectomy in gynecologic cancer.

背景：当前，淋巴结清扫术（lymphadenectomy）可经腹腔入路或经腹膜外入路实施。然而，两种入路各有优劣。鉴于此，我们研发了一种经脐腹腔镜单孔（transumbilical laparoendoscopic single-site, TU-LESS）经腹膜外入路用于淋巴结清扫术。本研究的核心目标在于验证该新型入路应用于系统性淋巴结清扫术的可行性，并逐步展示完整的手术操作流程。
方法：2020年5月至2021年6月期间，符合系统性淋巴结清扫术指征的患者接受了经TU-LESS经腹膜外入路的淋巴结清扫术。本研究详细阐述了该新型术式的操作要点，并收集并分析了患者的临床特征与手术结局。
结果：本研究共纳入8例妇科恶性肿瘤（gynecological carcinoma）患者，其中4例为高危子宫内膜癌，4例为早期卵巢癌。所有患者均成功实施经TU-LESS经腹膜外入路盆腔及腹主动脉旁淋巴结清扫术，无中转开腹情况。术中共获取中位盆腔淋巴结26.5枚（范围18~35枚）、中位腹主动脉旁淋巴结18.0枚（范围7~43枚）。手术时长中位值为166.5分钟（范围123~205分钟）。患者术后恢复顺利，未出现任何并发症。术后所有患者疼痛应答良好，且美容效果与躯体外观满意度均佳。
结论：我们的初步临床经验证实，经TU-LESS经腹膜外入路实施系统性淋巴结清扫术具备可行性。该新型术式可为妇科恶性肿瘤的淋巴结清扫术提供全新的术式选择或有益补充。