Three-Dimensional Imaging-Guided Safe Para-Aortic Lymph Node Dissection Using the Inferior Mesenteric Artery as an Intraoperative Landmark in a Patient with Renal Vascular Variation

In gynecologic oncology, para-aortic lymph node dissection is typically performed up to the level of the left renal vein. Although the renal arteries usually originate from the aorta, cranial to the renal veins, their anatomical course varies from person to person, and sometimes, the renal arteries are located within the para-aortic dissection area. Herein, we present a case of endometrial cancer involving three left renal arteries, two of which were located caudal to the renal vein. Preoperative three-dimensional (3D) reconstruction accurately depicted the vascular variation and provided precise measurements from the origin of the inferior mesenteric artery (IMA) to the accessory arteries. During surgery, the IMA was used as a landmark to identify and preserve renal arteries during para-aortic lymph node dissection. This case demonstrates the practical advantages of preoperative 3D imaging in visualizing complex retroperitoneal vascular variation, ensuring surgical safety, and enhancing anatomical understanding in gynecologic oncology.