Intraoperative identification and management of renovascular anatomical variations during paraaortic lymphadenectomy - an illustrated surgical experience

Sep 23, 2026

Uploaded by James

Renovascular anatomical variations create intraoperative risk during paraaortic lymphadenectomy (PaLA) in gynecologic oncology. This retrospective single-center study reviewed 42 patients with gynecologic malignancies treated in Ankara between February 2024 and February 2025. Renovascular variants were identified intraoperatively, photographed, and anatomically classified. Variations occurred in 21.4%, with inferior polar renal arteries (11.9%) and retroaortic left renal vein (9.5%). Recognized variations showed no vascular injury; most were detected preoperatively.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

Purpose

Methods

Results

Conclusion

Introduction

Para-aortic lymphadenectomy context

Renovascular variations and risks

Study aim

Ceylan and Aksel BMC Surgery (2026) 26:225 [https://doi.org/10.1186/s12893-026-03601-z](https://doi.org/10.1186/s12893-026-03601-z) BMC Surgery RESEARCH Open Access Intraoperative identification and management of renovascular anatomical variations during paraaortic lymphadenectomy: an illustrated surgical experience Özgün Ceylan1,2* and Tuba Zengin Aksel1 Abstract Purpose Renovascular anatomical variations pose potential surgical challenges during paraaortic lymphadenectomy (PaLA) in gynecologic oncology. This study aimed to document the prevalence and intraoperative characteristics of renovascular variations encountered during PaLA, and to describe their management through detailed photographic documentation. Methods This retrospective single-center observational study included 42 patients with gynecologic malignancies (24 endometrial, 16 ovarian, 2 cervical cancers) who underwent PaLA at Ankara, Türkiye, between February 2024 and February 2025. Procedures were performed laparoscopically (n = 20, 47 . 6%) or via laparotomy (n = 22, 52 .4%) . Patients underwent preoperative contrast-enhanced abdominal CT (slice thickness ≤ 3 mm) . Renovascular variations were identified intraoperatively, photographed, and classified anatomically. Results Renovascular variations were identified in 9 patients (21 .4%) . Inferior polar renal arteries occurred in 5 patients (11 . 9%): 2 bilateral, 3 unilateral right-sided. Retroaortic left renal vein was encountered in 4 patients (9 . 5%) . Preoperative imaging identified variations in 8 of 9 cases (88 . 9%), with one small-caliber artery missed on imaging. No vascular injuries occurred in cases with recognized variations. All laparoscopic cases with variations (n = 4) were completed without conversion. Conclusion Renovascular variations occurred in one-fifth of patients undergoing PaLA in this series. While preoperative imaging identified most variations, intraoperative vigilance remains essential. With careful surgical technique and anatomical awareness, these variations can be safely managed, though the small sample size limits generalizability. This series provides educational documentation for gynecologic oncologists. Keywords Gynecologic oncology, Paraaortic lymphadenectomy, Polar artery, Retroaortic vein, Vascular variations *Correspondence: Özgün Ceylan [ozguncyln@hotmail.com](ozguncyln@hotmail.com) 1Department of Gynecologic Oncology, Etlik City Hospital, Ankara, Turkey 2Güvenevler Mah. Ciftevler [sok. no:8/6 Cankaya](sok. no:8/6 Cankaya), Ankara, Turkey © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Ceylan and Aksel BMC Surgery (2026) 26:225 Introduction Para-aortic lymphadenectomy (PaLA) is a critical surgical procedure in the management of gynecologic malignancies, particularly for endometrial, ovarian, and selected cervical cancers. The anatomical boundaries of para-aortic

FAQs

What was the purpose of this study?

To document the prevalence and intraoperative characteristics of renovascular variations during paraaortic lymphadenectomy and to describe their management using detailed photographic documentation.

How was the study conducted and who were the participants?

It was a retrospective, single-center observational study including 42 gynecologic oncology patients who underwent PaLA in Ankara between February 2024 and February 2025.

What renovascular variations were found most often, and were there any vascular injuries?

Inferior polar renal arteries were found in 5 patients and retroaortic left renal vein in 4 patients. No vascular injuries occurred in cases with recognized variations.

Sep 23, 2026

Uploaded by James