Pelvic paraaortal lymph node dissection/samplingMedical editor Claes Tropè MD
Oslo University Hospital
In a pelvic/paraaortal lymph node dissection, the lymph nodes in the pelvis and along the aorta and vena cava are completely removed. This is done to diagnose microscopic spreading of tumor cells.
In pelvic/paraaortal lymph node sampling, the pelvic lymph nodes and paraaortal lymph nodes are examined for microscopic spreading. Visible lymph nodes are removed, but not all the lymphatic tissue.
Dissection/staging of pelvic/paraaortal lymph nodes is performed as a separate surgical procedure, or combined with a larger procedure (for example radical ovarian surgery). When the procedure is carried out separately, it is performed as conventional laparascopic or robot-assisted surgery. A pelvic lymph node dissection is always performed for cervical cancer, for ovarian and uterine cancer.
- Cervical cancer
- Uterine cancer
- Ovarian cancer
- Fallopian tube cancer
- Diagnose microscopic tumor spreading
- Large bowel emptying
- Thrombosis prophylaxis
- Open the space between the ureter and the pelvic wall.
- Hold the ureter on the medial side and dissect down on the lateral side.
- Open the paravesical space.
- Split the tissue over the external iliac artery.
- Use forceps and start on the medial side. Hold the nodes while the assisting surgeon carefully releases them.
- Spare femoral genital nerve to avoid paralysis.
- Localize the obturator nerve in the obturator fossa.
- Locate the lymph nodes above this and remove them.
- Remove the lymph nodes by the common iliac artery.
- Use clamps to secure lymphatic vessels if needed.
- Extirpate the same amount of lymph nodes from both sides.
- Put the lymph nodes in formalin for evaluation by a pathologist.
- Standard observation for postoperative complications