Novel anatomical concept and standardized technique for single-port Paraaortic lymphadenectomy in gynecological cancers

Objective

To evaluate the feasibility, safety, and quality of a standardized technique for single-port laparoscopic paraaortic lymphadenectomy guided by a novel anatomical concept.

Methods

This single-center prospective study enrolled patients with gynecological cancers requiring paraaortic lymphadenectomy from February 2022 to May 2025. All patients underwent single-port laparoscopic paraaortic lymphadenectomy using a standardized technique grounded in a novel “renal vein angle” anatomical concept. Primary endpoints assessed technical feasibility (completion rate), safety (intra/postoperative complications, blood loss), and quality (paraaortic lymphadenectomy to renal vein level, operative time, lymph node yield). All procedures were video-documented in high-definition or captured via time-stamped photographic key steps.

Results

Sixty consecutive patients underwent single-port laparoscopic paraaortic lymphadenectomy, including 52 with endometrial cancer, seven with ovarian cancer, and one with cervical cancer. The median patient age was 54 years, and the median BMI was 25.6 kg/m². The standardized technique achieved a 100 % completion rate with 100 % skeletonization of the left renal vein, inferior vena cava, and aorta. The median number of dissected para-aortic lymph nodes was 21 (range 11–37). The median operative duration was 95 min (range 53–285), and the median blood loss was 30 mL (range 5–150). No major complications, conversions to laparotomy, or additional trocar placement were observed. Ten patients had nodal metastases on postoperative pathological examination. No recurrence or delayed complications were observed after a median follow-up period of 15 months (range 0–38).

Conclusion

The standardized technique guided by novel anatomical concept demonstrated sufficient feasibility, safety, and quality for single-port laparoscopic paraaortic lymphadenectomy.