Initial experience of para-aortic lymph node dissection(PALND) using robotic single-site platform in a patient with locally advanced cervical cancer

Abstract

Objective: To introduce initial experience of lower para-aortic lymph node dissection (PALND) using robotic single-site platform in locally advanced cervical cancer. Patients: A 35-year-old patient was diagnosed with locally advanced cervical cancer (FIGO stage IB1). Body mass index was 20.82 kg/m2. The patient had no history of prior surgery or comorbidity. Interventions: We performed robotic single site radical hysterectomy, left salpingo-oophorectomy, right salpingectomy, bilateral pelvic lymph node and lower para-aortic lymph node dissection. After cervical injection of indocyanine green, the patient was tilted to the left for PALND. Through a single multi-channel port, inserted through the umbilicus, PALND was performed using the da Vinci Si Surgical System (Intutitive Surgical, Sunnyvale, CA) which was docked to patient’s right side. After PALND, patient was tilted to back to the Trendelenburg position (at a 30-degree angle) with daVinci Si Surgical System docked toward the patients between legs. Measurements/Results: The operation was performed successfully without any complication. The total operation time was 127 minutes, and the estimated blood loss was 50 mL. The pathology revealed adenocarcinoma. Total 17 bilateral pelvic lymph nodes and 4 para-aortic lymph nodes were retrieved which were negative. Conclusions:With side docking and position change, robotic single site lower para-aortic lymph node dissection is feasible in select patients within appropriate time range. Robotic single-site radical hysterectomy including bilateral pelvic lymph node and paraaortic lymph node dissection could be a minimally invasive surgical option in select patients with locally advanced cervical cancer. Design: A video case report. Settings: A tertiary teaching hospital.