External Iliac Vessel Mobilization via Ilio-Lumbar Fossa Opening: Impact on Safety and Yield of Laparoscopic Pelvic Lymphadenectomy

Abstract

Background: Pelvic lymphadenectomy is an important component of surgical staging in early-stage cervical and endometrial cancers. However, limited access to the deep obturator fossa and common iliac bifurcation can make laparoscopic dissection technically challenging and may increase the risk of vascular injury. Mobilisation of the external iliac vessels through opening of the ilio-lumbar fossa may improve exposure of these anatomical areas and facilitate safer and more complete lymph node dissection.  Objective: To evaluate whether external iliac vessel mobilisation through ilio-lumbar fossa opening is associated with differences in lymph node yield, operative time, and intraoperative safety during laparoscopic pelvic lymphadenectomy. Methods: This retrospective comparative study included 40 patients with early-stage cervical or endometrial cancer treated at the SCOPE CLINIC, Cairo Center for Advanced Laparoscopic, Robotic & Pelvic Surgery, between 2023 and 2025. Twenty patients underwent the standard fixed-vessel technique (Group A), and 20 underwent external iliac vessel mobilisation (Group B). Outcomes included total, obturator, and common iliac bifurcation lymph node counts, lymphadenectomy time, vascular and nerve injuries, and junior specialist preference. Results: Mean total lymph node yield was higher in Group B than in Group A (18.5 ± 4.2 vs. 13.2 ± 3.1; p < 0.01). Obturator node yield (8.8 ± 2.1 vs. 5.1 ± 1.5; p < 0.01) and bifurcation node yield (4.2 ± 1.2 vs. 2.4 ± 0.8; p < 0.05) were also higher. Mean lymphadenectomy time was shorter in Group B (32 ± 8 vs. 44 ± 4 min; p < 0.01). No vascular or nerve injuries occurred in Group B, whereas two venous injuries occurred in Group A. Junior specialists preferred the mobilisation technique in 85% of assessments. Conclusion: External iliac vessel mobilisation through ilio-lumbar fossa opening was associated with greater nodal yield and shorter lymphadenectomy time in this cohort, with no vascular injuries observed in the mobilisation group. Larger prospective studies are required to confirm these findings.