Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy

Objective: To increase vigilance among gynecological surgeons for the presence of accessory polar renal artery (APRA) encountered with transperitoneal systemic laparoscopic paraaortic lymphadenectomy (LPAL). Methods: A retrospective review was conducted on 156 women who underwent LPAL for various gynecologic malignancies between November 2003 and December 2009. Results: The median age, parity, body mass index, and number of previous abdominal surgeries, respectively, of the women were 52 years (range, 23-82 years), two (range, 0-7), 24.1 kg/m(2) (range, 17.4-35.0 kg/m(2)), and 0 (range, 0-3). During the study period, we found four women with APRA. There were three cases of right lower APRAs arising from the abdominal aorta, caudal to the inferior mesenteric artery (IMA), terminating at the parenchyma of the lower pole of the right kidney. In the other case, the APRA arose from the abdominal aorta superior to the IMA. There were no vascular complications, such as transection or ligation of the APRA. Conclusion: It is important for the gynecological oncologic surgeon to have knowledge of retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during LPAL.