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Single-Port Laparoscopic Pelvic and Para-Aortic Lymph Node Sampling or Lymphadenectomy: Development of a Technique and Instrumentation

Background and Objectives: Innovations in minimally invasive surgery have allowed surgeons to perform increasingly complex surgeries through smaller incisions. We describe the feasibility and the technique of single-port laparoscopic pelvic and para-aortic lymph node sampling or lymphadenectomy in gynecologic malignancies. Methods: The study was approved by the institutional review board at the Cleveland Clinic (Cleveland, Ohio). Inclusion criterion was patients with apparent early-stage gynecologic malignancies who required pelvic and/or para-aortic lymph node sampling or lymphadenectomy and were candidates for single-port laparoscopy. Procedures were performed through a single 2.0- to 3.0-cm umbilical incision using a single-port device, deflecting-tip laparoscope, and multifunctional instrumentation. Results: Twenty-one patients underwent single-port surgery/staging performed during the study period. The median patient age was 58 years (range, 17-80 years), and the median patient body mass index was 30 mg/kg2 (range, 19-46 mg/kg2). Median overall operating time was 120 minutes (range, 60-185 minutes). Median pelvic and para-aortic node counts were 14 (range, 7-19) and 6 (range, 2-14), respectively. Conclusions: In this preliminary report, the technique was feasible, and no morbidity was noted. Further studies are needed to better define the ideal gynecologic oncology procedures for single-site surgery and to assess the relative benefits of this new technique compared with more conventional minimally invasive approaches.