Summary

Our aim was to provide a stepwise demonstration of laparoscopic excision of enlarged lymph nodes at the level of the iliac vessels. A 31-year-old woman visited the clinic because of abnormal uterine bleeding. Endometrial curettage revealed a mixed clear cell and endometrioid adenocarcinoma. Preoperative magnetic resonance imaging indicated superficially invasive lesions and no extrauterine involvement was detected. Her serum cancer antigen 125 level was 52.68 U/mL. Total hysterectomy, bilateral salpingo-oophorectomy, and surgical staging by laparoscopy were scheduled. During the procedure, it was found that the lymph nodes at the level of the right iliac vessels were enlarged and dense adhesions were observed between the enlarged nodes and the iliac vessels. Dissection of these lymph nodes is challenging and associated with a high risk of vessel injury, which may lead to severe hemorrhage if performed by inexperienced surgeons. Thus we highlighted the key anatomic structures surrounding the enlarged lymph nodes and summarized the procedure in six reproducible steps (Online Supplemental File 1): (1) opening of the retroperitoneum and development of the pelvic spaces; (2) dissection and medicalization of the ureter; (3) lysis of the adhesions between the enlarged lymph nodes and the internal iliac artery; (4) identification of the obturator nerve and the internal iliac vein; (5) lysis of the adhesions between the enlarged lymph nodes and the external iliac vein; and (6) mobilization of the cranial end of the enlarged lymph nodes. Finally, we resected the enlarged lymph nodes safely. The final pathological reports confirmed metastasis of the pelvic lymph nodes. The patient received six courses of carboplatin/paclitaxel combination therapy after surgery. She is still in complete remission 11 months after surgery. In summary, laparoscopic excision of enlarged lymph nodes at the level of the right iliac vessels was achieved safely with exposure of key anatomic structures surrounding the target lesions.1

Figure 1

Enlarged lymph nodes at the level of the right iliac vessels.

Video 1 Stepwise demonstration of laparoscopic excision of enlarged lymph nodes at the level of the right iliac vessels.Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Ethics statementsPatient consent for publication

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Ethics approval

This study involves human participants and was approved by the institutional review board of the Obstetrics and Gynecology Hospital of Fudan University (No 2022-13; date, 2022-01-24). Participants gave informed consent to participate in the study before taking part.