Lymphadenectomy is an integral part of staging and treatment of gynecologic malignancies.We evaluated the feasibility and oncologic value of l aparoscopic transperi-toneal pelvic and paraaortic lymphadenectomy in correla-tion to complication rate and body ma ss index.Between August 1994and September 2003,pelv ic and /or paraaortic transperitoneal laparo scopic lymphadenectomy was performed in 650patients at the D epartment of Gy-necology of the Friedrich -Schiller University of Jena.Retrospective and prospective data collection and evalua-tion of videotapeswere possible in 606patients.Laparo-scopic lymphadenectomy was part of t he following surgi-cal procedures:staging laparoscop y in patientswith ad-vanced cervical cancer(n =133)or early ovarian cancer(n =44),trachelectomy in patients with early cervical cancer(n =42),laparoscopic -assisted radical vaginal hysterectomy in patients with cervical cancer(n =221),laparoscopy before exenteration in patients with pelvic re-currence(n =20),laparoscopic -assisted vaginal hys-terectomy or laparoscopic -assiste d radical vaginal hys-terectomy in patients with endometr ial cancer(n =112),and operative procedures for other i ndications(n =34).After a learning period of approxima tely 20procedures,a constant number of pelvic lymph nodes(16.9-21.9)was removed over the years.Pelvic lymphadenectomy took 28min,and parametric lymphadenectom y took 18min for each side.The number of removed para aortic lymph nodes increased continuously over the yea rs from 5.5to 18.5.Right -sided paraaortic,left -sided inframesenteric and left -sided infrarenal lymphadenec tomy took an average of36,28,and 62min,respectively.The number of removed lymph nodeswas independent from the body mass index of the patient.Duration of pelvic lymp hadenectomywas inde-pendent of body mass index,but right -sided paraaortic lymphadenectomy lasted significan tly longer in obese women(35vs.41min,P =0,011).The overall com-plication rate was 8.7%with 2.9%int raoperative(vessel or bowel injury)and 5.8%postoperative complicatio ns.No major intraoperative complicati on was encountered during the last 5years of the study.B y transperitoneal laparoscopic lymphadenectomy,an a dequate number of lymph nodes can be removed in an adequate time and independent from body mass index.The complication rate is low and can be minimized by standardization of theprocedure.
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