Robotic-Assisted Dissection of Bulky Lymph Nodes in Cervical Cancer

The resection of bulky lymph node metastases, which may provide a therapeutic benefit, has been proposed in several studies based on laparotomy and laparoscopy. There is no published study in the literature examining the resection of bulky lymph node metastases using a robotic technique. In this report, we presented a patient with cervical cancer who underwent robotic-assisted dissection of bulky lymph nodes. The robotic-assisted operation time was 255 minutes, and the mean console time was 215 minutes. The estimated blood loss was 70？mL. The number of lymph nodes retrieved was 28, and the number of the dissected paraaortic lymph nodes was 13. The number of the lymph node metastases was eight. The bulky lymph nodes which are difficult to be eradicated with standard radiation therapy can be resected with robotic-assisted surgery and successful resection of the lymph nodes can improve the treatment strategy. This minimal invasive technique is safe and feasible for bulky lymph node dissection. 1. Introduction Despite improvements in the screening and treatment modalities for preinvasive cervical lesions, the mortality rate of cervical cancer has not decreased in the last three decades, and cervical cancer has continued to become one of the most common cancers in women, especially those living in developing countries [1]. The most important prognostic factor for patients with cervical cancer is the presence of lymph node metastases [2]. Although importance of this factor has been confirmed in several studies, the International Federation of Obstetrics and Gynecology (FIGO) staging of carcinoma of the cervix depends on clinical findings and does not include lymph node metastasis [3]. The treatment of cervical cancer depends on various factors, such as the FIGO stage of the disease, the histological subtype, the depth of invasion, and the lymph node status [4]. Surgery, radiotherapy, and chemoradiotherapy can be used separately or together according to the situation. Radiotherapy is preferred if lymph node involvement is detected before surgery, but in the case of bulky lymph nodes, there is a conflict regarding the use of radiotherapy. A 50- to 60-Gray dose should not be exceeded because higher doses cause severe toxicity to the neighboring organs, particularly the small bowel. Conversely, this dosage is not sufficient to sterilize bulky lymph nodes >2？cm [5]. The resection of bulky lymph node metastases, which may provide a therapeutic benefit, has been proposed in several studies based on laparotomy and one pilot study performed by laparoscopy [6]. There