Enhancing sampling completeness by combining the right-sided and left-sided extraperitoneal approaches in laparoscopic para-aortic lymphadenectomyOBJECTIVE: Reports describing laparoscopic para-aortic lymphadenectomy in the management of gynecologic malignancy vary in terms of approach, risk, advantage, and completeness. We submit our experience with the technique of extraperitoneal laparoscopy that allows excellent visualization and extensive retroperitoneal dissection from the infrarenal aorta to the bifurcation of the common iliac artery on both sides.METHOD: Patients with gynecologic malignancies underwent laparoscopy for surgical staging. Using lateral extraperitoneal approaches varing from left-sided only, right-sided only, to bilateral, laparoscopic para-aortic lymphadenectomy was performed in 34 patients.RESULTS: Excellent bilateral retroperitoneal exposure was achieved. An extensive dissection was performed bilaterally from the level of renal vessels to the bifurcation of the common iliac artery in each approach. The bilateral extraperitoneal approach enabled a complete para-aortic dissection. All patients were completely staged laparoscopically. The average number of lymph nodes sampled was 32.9 (range 8 to 96) with an estimated blood loss of < 160ml. Operative time ranged from 105-285min. There were no serious intra-operative complications.CONCLUSION: Our experience demonstrates that laparoscopic extraperitoneal para-aortic access and node sampling is safe and feasible. Adding opposite-side extraperitoneal access, a complete bilateral para-aortic lymphadenectomy was achieved.