Nasuh Utku Dogan1, Selen Dogan2, Merve Erol3, Burcu Tas Uzun3. 1. Akdeniz University, Department of Ob&Gyn, Turkey. Electronic address: nasuhutkudogan@yahoo.com. 2. University of Ministry of Health, Antalya Research Hospital Antalya, Turkey. 3. Akdeniz University, Department of Ob&Gyn, Turkey.
Abstract
OBJECTIVE: Cisterna chyli is a pearl-shaped elongated lymphatic structure located at the level of L1-L2 vertebra just beneath the aorta (Hsu and Itkin, 2016 [1]). It receives lymphatic drainage of intestines and lower body structures (Loukas et al., 2007 [2]). Size, shape and location are all highly variable and in some autopsy series CC was identified in only half of the cases (Song, 2016 [3]). During the laparoscopic paraaortic lymphadenectomy inadvertent injury to otherwise unidentified CC could lead to refractory chylous ascites (Favero et al., 2010 [4]). The objective of this video is to demonstrate the anatomic localization and consequences of inadvertent injury to CC in laparoscopic paraaortic lymphadenectomy. METHODS: Two different patients undergoing laparoscopic paraaortic lymphadenectomy were presented. RESULTS: The first case is a 51 year old woman with grade III endometrioid adenocarcinoma of uterus who was subjected to laparoscopic staging (laparoscopic hysterectomy + BSO + pelvic and paraaortic lymphadenectomy). Intraoperatively an injury to cisterna chyli occurred which was sealed and repaired immediately. The second case is a woman with stage IIB clear cell cervical cancer undergoing laparoscopic staging (pelvic and paraaortic lymphadenectomy). In this case cisterna chyli could be recognized and preserved. CONCLUSION: Cisterna chyli is an important anatomic structure which should be identified and preserved during laparoscopic paraaortic lymphadenectomy. Any iatrogenic injury to cisterna chyli could lead to chylous ascites and indeed in minority of these cases surgical intervention is required.
OBJECTIVE: Cisterna chyli is a pearl-shaped elongated lymphatic structure located at the level of L1-L2 vertebra just beneath the aorta (Hsu and Itkin, 2016 [1]). It receives lymphatic drainage of intestines and lower body structures (Loukas et al., 2007 [2]). Size, shape and location are all highly variable and in some autopsy series CC was identified in only half of the cases (Song, 2016 [3]). During the laparoscopic paraaortic lymphadenectomy inadvertent injury to otherwise unidentified CC could lead to refractory chylous ascites (Favero et al., 2010 [4]). The objective of this video is to demonstrate the anatomic localization and consequences of inadvertent injury to CC in laparoscopic paraaortic lymphadenectomy. METHODS: Two different patients undergoing laparoscopic paraaortic lymphadenectomy were presented. RESULTS: The first case is a 51 year old woman with grade III endometrioid adenocarcinoma of uterus who was subjected to laparoscopic staging (laparoscopic hysterectomy + BSO + pelvic and paraaortic lymphadenectomy). Intraoperatively an injury to cisterna chyli occurred which was sealed and repaired immediately. The second case is a woman with stage IIB clear cell cervical cancer undergoing laparoscopic staging (pelvic and paraaortic lymphadenectomy). In this case cisterna chyli could be recognized and preserved. CONCLUSION: Cisterna chyli is an important anatomic structure which should be identified and preserved during laparoscopic paraaortic lymphadenectomy. Any iatrogenic injury to cisterna chyli could lead to chylous ascites and indeed in minority of these cases surgical intervention is required.