Transperitoneal laparoscopic pelvic lymphadenectomy for gynecologic malignancies (I) : Technique and results.
We reviewed the published experimental and clinical data. available in MEDLINE, and compared them to our experience in a university-affiliated tertiary medical center of obstetrics and gynecology in order to describe the accepted techniques and results of laparoscopic pelvic lymphadenectomy.
The procedure requires a four-port access laparoscopy.
Dissection boundaries are similar to those for open surgery.
Experimental and clinical comparative series have shown that the number of harvested lymph nodes is not significantly different for laparoscopy than for laparotomy.
Several authors reported a learning curve, reflecting the surgeons increasing accuracy with growing operative experience.
Obesity and prior history of laparotomy are both factors that impact adversely on the number of nodes harvested and the complication rate.
Otherwise, the number of residual nodes is similar for the two approaches, In both cases, it is low, resulting in a high sensitivity (95-100%). The complication rate is directly linked to the surgeon's experience and thus appears low for skilled laparoscopic operators.
It is similar to that reported for open surgery.
Anesthesiological complications have not been well assessed in the literature on laparoscopic lymphadenectomy.
Operating time was longer than for laparotomy in all the series.
Conversely, mean blood loss, duration of hospitalization, and recovery time were significantly decreased. (...)
Mots-clés Pascal : Tumeur maligne, Appareil génital femelle, Traitement associé, Résection chirurgicale, Ganglion lymphatique, Petit bassin, Laparoscopie, Technique, Résultat, Analyse avantage coût, Revue bibliographique, Homme, Femelle, Appareil génital femelle pathologie, Chirurgie, Endoscopie, Economie santé
Mots-clés Pascal anglais : Malignant tumor, Female genital system, Combined treatment, Surgical resection, Lymph node, Pelvis minor, Laparoscopy, Technique, Result, Cost benefit analysis, Bibliographic review, Human, Female, Female genital diseases, Surgery, Endoscopy, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0074162
Code Inist : 002B25K. Création : 14/05/1998.