Laparoscopic lymph node dissection

Objective Laparoscopic lymph node dissection in the treatment of endometrial, cervical and ovarian cancer, endoscopic axillary dissection in breast cancer and endoscopic inguinal dissection in vulval cancer are surgical techniques that have been developed over the last 10 years. The careful investigation of this endoscopic field in selected cases of gynaecological malignancy was attempted in a combined study. It is the aim of the present paper to assess the endoscopic possibilities of lymphadenectomy while observing the same oncological principles as the laparotomy approach. Endoscopic surgical techniques may give patients a better quality of life within the treatment of their malignant condition. Design Clinical retrospective evaluation. Setting The study was carried out at the Department of Obstetrics and Gynaecology, University of Kiel, Germany and at the Oncological Centre in Warsaw Poland. Subjects 60 patients were treated by endoscopic lymphadenectomy, and 38 of these were treated for endometrial cancer stages I and II according to the FIGO (International Federation of Obstetricians and Gynaecologists) classification. Interventions Endoscopic pelvic lymphadenectomies and laparoscopic-assisted vaginal hysterectomies (LAVH) were performed. Main outcome measures Ease of performance of pelvic lymphadenectomies, and number of lymph nodes obtained compared with laparotomy. Results An average of 14 nodes per patient was removed. There were no complications. Conclusions The surgical approach to patients with endometrial cancer has changed. After laparoscopic surgical staging of endometrial cancer, the combined laparoscopic and vaginal surgical approach to treatment is possible, in properly selected patients by well-trained surgeons. Lymphadenectomy and LAVH seem to be optimal surgical techniques for the treatment of endometrial cancer.