الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: There are many published literature reviews on the safety and feasibility of laparoscopic staging surgery of gynecological malignancies. The laparoscopic para-aortic lymphadenectomy could be carried out by two main approaches: the transperitoneal and the extraperitoneal approaches. However, there is a debate on which approach, either trans- or extraperitoneal, is superior for the performance of laparoscopic para-aortic lymphadenectomy. The aim of the work: to determine and compare surgical outcomes, nodal yield, and complication rates of both laparoscopic transperitoneal and extraperitoneal lymphadenectomy approaches in the management of gynecological malignancy cases, as well as the specific benefits and limitations for both approaches. Materials and Methods: Patients and Methods: Randomized controlled study was conducted at University Hospitals of Mansoura, Egypt (Oncology center Mansoura University and Department of Obstetrics and Gynecology) in collaboration with University Hospitals of Strasbourg (Department of Obstetrics and Gynecology, Hautepierre), France. In the period from March 2017 to October 2019 Results: 63 patients were included and randomized; 30 (47.6%) underwent transperitoneal PAL, and 33 (52.3%) underwent extraperitoneal PAL. The median duration of para-aortic lymphadenectomy was significantly longer in the transperitoneal PAL group compared with the extraperitoneal PAL group: 120 min (range 80–180 min) versus 90 min (range 68-130 min), respectively (p=0.002). Estimated Blood loss during para-aortic LND was significantly lower in the extraperitoneal group (p=0.03). Regarding the median number of harvested lymph nodes, the yield was lower in the transperitoneal PAL group: 11.5 (range 2-29) versus 13 (range 3-37) in the extraperitoneal group (p=0.92). There was no difference between both groups in terms of the overall post-operative complications (p=0.47). Conclusion: The extraperitoneal lymphadenectomy is a safe procedure and is non-inferior to the transperitoneal approach. Both approaches are comparable to each other, however, each technique has its points of strength and weakness that could be tailored in order to offer our patients, whenever possible, the best way of minimally invasive lymphadenectomy.