Transumbilical laparoendoscopic single-site surgery (TU-LESS) extraperitoneal approach for lymphadenectomy: an innovative method

Objective In gynecological oncology surgery, pelvic lymphadenectomy and para-aortic lymphadenectomy is a critical surgical staging procedure. Multiple methods have been used to perform lymphadenectomy. Compared with multiport laparoscopy, the central incision of transumbilical laparoendoscopic single-site surgery (TU-LESS) provides equal access to the para-aortic and bilateral obturator region [1]. And it is accepted that extraperitoneal approach is ideal for lymphadenectomy, which avoids intestinal disturbance and reduce intra-abdominal adhesion [2]. Therefore, we developed TU-LESS extraperitoneal approach for lymphadenectomy, which combined the benefits of these aforementioned methods. Methods This study was approved by the Ethics Committee of West China Second University Hospital of Sichuan University (No. 150). A video is applied to demonstrate each steps for this specific technique. Step 1: Create TU-LESS intraperitoneal approach. Step 2: Pinpoint the peritoneal position. Step 3: Insert the port and create retroperitoneal pneumonia. Step 4: Remove lymph nodes through TU-LESS extraperitoneal approach. Step 5: Operate intraperitoneal surgery. Results This micro-invasive approach reduces the risk of direct bowel injury, adhesion formation, wound complications. For gynecologic cancer patients, especially for the advanced cervical cancer, this micro-invasive approach not only provide accurate staging but also achieve enhanced recovery following surgery, thus patients could receive subsequent adjuvant radio/chemotherapy on time. Conclusion TU-LESS extraperitoneal approach is an innovative method for lymphadenectomy.