Introduction. This study was designed to confirm the feasibility and safety of robotic-assisted transperitoneal aortic lymphadenectomy as part of staging procedure for gynecologic malignancies. Methods. Chart review of 51 patients who had undergone robotic staging with aortic lymphadenectomy for different gynaecologic malignancies was performed. Results. The primary diagnosis was as follows: 6 cases of endometrial cancer, 31 epithelial ovarian cancer, 9 nonepithelial ovarian cancer, 4 tubal cancer, and 1 cervical cancer. Median BMI was 23？kg/m2. Except for a single case of aortic lymphadenectomy only, both aortic and pelvic lymphadenectomies were performed at the time of the staging procedure. All the para-aortic lymphadenectomies were carried out to the level of the renal veinl but 6 cases were carried out to the level of the inferior mesenteric artery. Hysterectomy was performed in 24 patiens (47%). There was no conversion to LPT. The median console time was 285 (range 195–402) with a significant difference between patients who underwent hysterectomy and those who did not. The median estimated blood loss was 50？mL (range 20–200). The mean number of removed nodes was . The mean number of pelvic nodes was , whereas the mean number of para-aortic nodes was . Conclusions. Robotic transperitoneal infrarenal aortic lymphadenectomy as part of staging procedure is feasible and can be safely performed. Additional trocars are needed when pelvic surgery is also performed. 1. Introduction The feasibility and safety of robotically assisted para-aortic lymphadenectomy (PAL) have been already well reported, both with the robotic setup for pelvic surgery or with the sovrapubic approach [1, 2]. However, the upper limit, up to the left renal vein, is still debated, and technical aspects of PAL may differ depending on whether this procedure is the only one performed, or it is combined with other staging procedures for gynaecologic malignancies, such as pelvic lymphadenectomy, hysterectomy, omentectomy, and random peritoneal sampling. The inframesenteric aortic nodes in most patients can be accessed and removed with the robotic setup for pelvic surgery. However, removal of the infrarenal aortic nodes up to the renal veins and, in particular, the left group can be very challenging. The infrarenal nodes have been reported as one of the most common site of nodal metastases in epithelial ovarian cancer, and recently they have been shown to be positive nodes in the absence of metastases in the ipsilateral inframesenteric nodes in endometrial cancer [3]. One of the major
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