De novo adhesions with extraperitoneal endosurgical para-aortic lymphadenectomy versus transperitoneal laparoscopic para-aortic lymphadenectomy: a randomized experimental study

Am J Obstet Gynecol. 2000 Sep;183(3):529-33. doi: 10.1067/mob.2000.105736.


Objective: The objective of this study was to compare the risk of adhesion formation and the site of postoperative adhesions after transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy.

Study design: A prospective study was conducted on 66 pigs, randomly allocated to 2 groups of 33 animals that underwent transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy.

Results: No statistically significant difference was observed between the 2 techniques in terms of operating time, number of lymph nodes removed, and intraoperative and postoperative morbidity. More lymphoceles were observed in the extraperitoneal laparoscopy group (P =.0002). The overall adhesion rates were 76% in the transperitoneal group and 43.33% in the extraperitoneal group (P =.04). The adhesion score specific to the operative site was lower in the extraperitoneal group (P =.0005). A stereolocalization study showed that almost all adhesions after transperitoneal laparoscopy were situated in the para-aortic external irradiation field, whereas adhesions after extraperitoneal laparoscopy were predominantly situated outside this field.

Conclusion: Extraperitoneal laparoscopy generates significantly fewer adhesions in the para-aortic irradiation field.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Aorta
  • Female
  • Laparoscopy / adverse effects*
  • Lymph Node Excision / adverse effects*
  • Lymph Node Excision / methods*
  • Peritoneum*
  • Prospective Studies
  • Swine
  • Tissue Adhesions / epidemiology*
  • Tissue Adhesions / etiology