Preservation of Six Renal Arteries in Laparoscopic Para-Aortic Lymphadenectomy: A Case Report

The presence of more than one renal artery has been commonly observed, and approximately 10% - 40% of examined cadavers have an accessory renal artery, which corresponds to each segmental artery. Thus, it is important to preserve these arteries during para-aortic lymphadenectomy via laparotomy. Here, we present a case involving a patient with ovarian cancer who underwent laparoscopic para-aortic lymphadenectomy with preservation of six renal arteries. Although two left renal arteries were observed through contrast CT, surgical findings revealed two right and four left renal arteries, including blood vessels, which were not identified preoperatively. Moreover, a subtype of the left renal vein was present. In previous reports on gynecological laparoscopic surgery, the maximum number of accessory renal arteries was two, which is a common finding. With regard to en bloc removal in laparoscopic para-aortic lymphadenectomy with renal vascular abnormalities, it is recommended to reduce the lymph nodes to the minimum size necessary to avoid tumor scattering, renovascular injury, and surgical field failure. Furthermore, it is difficult to diagnose renovascular abnormalities using only contrast CT preoperatively. Thus, in laparoscopic surgery, whereby the viewing direction of the operative field is fixed, the procedure should be performed with due consideration of the renovascular abnormalities. J Clin Gynecol Obstet. 2018;7(3-4):76-80 doi: https://doi.org/10.14740/jcgo505w