Robotic transperitoneal infrarenal aortic lymphadenectomy for gynecologic malignancy: A left lateral approach

Objective: To describe the technique and report patient outcomes of a left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy with subsequent pelvic surgery in patients with gynecologic malignancy. Methods: Outcome data were collected retrospectively from March 2009 to September 2010 for all patients undergoing a left lateral approach for robotic transperitoneal aortic lymphadenectomy using a right lateral decubitus position by a single surgeon. Outcomes were analyzed and compared. Results: The median total operating time was 213 minutes (range, 186-265). The median body mass index was 25.2 kg/m ² (range, 22.5-32.1). The median estimated blood loss was 150 mL (range, 50-550). The median length of hospital stay was 1 day (range, 1-2). The mean number of para-aortic lymph nodes was 8.2 (range 4-17). There were no conversions or perioperative complications in this 5-patient series. The mean follow-up was 12.8 months (range, 8-20). All patients underwent concomitant robotic hysterectomy and pelvic lymphadenectomy. Conclusions: A left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy using a right lateral decubitus position is safe and feasible. Minimal patient repositioning provides access for pelvic surgery using the same abdominal trocar placement.