Rectal mobilization for laparoscopic pelvic lymphadenectomy of the lower paracervical pathway in patients with uterine cancer

Abstract

ObjectiveThe pelvic lymphatic drainage system comprises the upper and lower paracervical pathways (LPPs). Lymph nodedissection of the LPP, including the cardinal ligament, internal iliac, internal common iliac, and presacral lymph nodes,requires higher surgical skills because of the anatomical limitations of the pelvic cavity and the dissection of vesselswhile preserving the nerves in the pelvic floor. In this video, we demonstrate rectal mobilization for laparoscopiccomplete pelvic lymph node dissection of the LPP in patients with uterine cancer. MethodsRectal mobilization was performed before complete pelvic lymph node dissection of the LPP. The pararectal space wasopened widely and the connective tissue between the presacral fascia and prehypogastric nerve fascia was dissectedbilaterally, allowing the rectum to be pulled. ResultsThis procedure created a wide-open space in the pelvic floor, allowing clear visualization of the nerves and lymphnodes of the LPP. Laparoscopic complete lymph node dissection of the LPP was performed in the open space whilepreserving the hypogastric and pelvic splanchnic nerves and isolating the extensive network of blood vessels in thepelvic cavity. ConclusionRectal mobilization enabled the safe execution of laparoscopic complete pelvic lymph node dissection of the LPP inpatients with uterine cancer.