Robotic paraaortic lymphadenectomy in oncogynecology. Double side docking of daVinci S system increases the success rates of high paraaortic lymph node dissection in endometrial cancer.

OBJECTIVE: To present an overview of minimally invasive approaches to suprapelvic lymphadenectomy and compare two different methods of staging robotic transperitoneal paraaortic lymphadenectomies in patients with early stages of endometrial cancer. DESIGN: Retrospective study and literature review. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc. METHODS: In this retrospective study we enrolled 70 patients with early stages of endometrial cancer undergoing staging robotic surgery at the Department of Obstetrics and Gynecology, University Hospital Olomouc from January 2016 to March 2018. Primary systematic pelvic and paraaortic lymphadenectomy was suggested in all patients. In 39 out of 70 patients single docking was used for robotic staging surgery, whereas in 28 patients the procedure was done using double side docking approach. Number of patients with total and infra-renal suprapelvic lymphadenectomy, number of para-aortic lymphonodes retrieved and the rate of lymphadenectomy complications were compared. RESULTS: Robotic surgery was performed in 67 (96%) out of 70 patients. In three cases (0,4%) laparoscopy was converted to laparotomy. Single side docking was used in 39 cases (58%), whereas in 28 patients (42%) double side docking was used. Paraaortic lymhadenectomy was performed in 45 cases (67%). In 16 patients (24%) the upper limit of the left renal wein was reached. Upper limit of paraaortic lymphadenectomy was above inferior mesenteric artery but did not reach left renal vein in 19 cases (28%). Inferior mesenteric represented upper limit of paraaortic lymphadenectomy in 10 patients (15%). Number of paraaortic lymphonodes retrived (4,9 ± 3,3 vs 3,7 ± 4,9, p = 0,028) as well as number of paraaortic lymphadenectomies with upper limit at the left renal vein (p < 0,0001) was higher in double side docking cases. Complication rates were low in both groups and the differences were not significant. CONCLUSION: Number of lymphonodes retrieved as well as the number of paraaortic lymphadenectomy cases with upper limit at the left renal vein was higher in double side docking group. Operating time, complication and conversion rates were low without differences between both groups.