Robotic-Assisted Laparoscopic Extended Pelvic Lymph Node Dissection for Prostate Cancer: Surgical Technique and Experience with the First 99 Cases

Published on Apr 1, 2009in European Urology20.096
· DOI :10.1016/J.EURURO.2008.12.006
Antje Feicke2
Estimated H-index: 2
(UZH: University of Zurich),
Martin Baumgartner22
Estimated H-index: 22
(UZH: University of Zurich)
+ 6 AuthorsRäto T. Strebel13
Estimated H-index: 13
(UZH: University of Zurich)
Abstract Background To date, there is still a paucity of data in the literature on robotic-assisted laparoscopic extended pelvic lymph node dissection (RALEPLND) in patients with prostate cancer. Objective To assess the technical feasibility of RALEPLND and to present our surgical technique. Design, setting, and participants From April 2006 to March 2008, we performed RALEPLND in 99 patients prior to robotic-assisted laparoscopic radical prostatectomy. Indications for RALEPLND were a prostate-specific antigen (PSA) ≥10 ng/ml or a preoperative Gleason score ≥7. The data were evaluated retrospectively. Surgical procedure The transperitoneal approach was used in all cases. In order to gain optimal access to the common iliac bifurcation, the five trocars were placed in a more cephalad position than in patients undergoing radical prostatectomy without RALEPLND. After identification of important landmarks, the lymphatics covering the external iliac vein, the obturator lymphatic packet, and the lymphatics overlying the internal iliac artery were removed on both sides. Measurements The total lymph node yield, the frequency of lymph node metastases, and the complication rate. Results and limitations The median patient age was 64 yr (range: 45–78). The median preoperative PSA level was 7.7 ng/ml (range: 1.5–84.6). The median number of lymph nodes harvested was 19 (range: 8–53). In 16 patients (16%), we found lymph node metastasis. Complications occurred in seven patients (7%). Conclusions RALEPLND is feasible, and its lymph node yield is well in the range of open series. The robotic-assisted laparoscopic approach in itself does not seem to limit a surgeon's ability to perform a complete extended pelvic lymph node dissection.
📖 Papers frequently viewed together
#1Alberto BrigantiH-Index: 99
#2Umberto CapitanioH-Index: 63
Last. Patrizio RigattiH-Index: 89
view all 14 authors...
Abstract Background Previous trials have shown that the number of procedures done by a single surgeon, that is, surgical volume (SV), is associated with several outcomes after radical prostatectomy (RP). Objective To test the association between SV and the detection of lymph node metastases during extended pelvic lymph node dissection (ePLND). Design, setting, and participants The study cohort consisted of 1020 men surgically treated for clinically localized prostate cancer. Intervention All pat...
#1Michael K Eng (U of C: University of Chicago)H-Index: 5
#2Mark H. KatzH-Index: 18
Last. Kevin C. ZornH-Index: 35
view all 6 authors...
Purpose: Port-site metastasis has been an increasing concern with the spread of laparoscopy in managing urologic malignancies. The purpose of this study was to provide a current review of port-site metastases reported in the urologic oncology literature, as well as etiologic factors and preventative measures. Methods: A comprehensive Medline search (up to September 2007; subject headings: “neoplasm seeding,” “laparoscopy,” “urologic neoplasms”) of all case reports and series related to laparosco...
#1Martin C. Schumacher (University of Bern)H-Index: 14
#2Fiona C. Burkhard (University of Bern)H-Index: 51
Last. Urs E. Studer (University of Bern)H-Index: 85
view all 5 authors...
Abstract Background Conflicting results exist regarding the value of an extended pelvic lymph node dissection (PLND) in node-positive patients undergoing radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Objective To assess the long-term outcome in node-positive patients who underwent extended PLND followed by RRP. Design, setting, and participants A consecutive series of 122 node positive patients with negative preoperative staging examinations, no neoadjuvant hor...
#1Michael MuschH-Index: 11
Last. Darko KroepflH-Index: 9
view all 4 authors...
Purpose: We evaluated the perioperative complications associated with pelvic lymphadenectomy in patients undergoing radical retropubic prostatectomy. In particular the influence of the extent of pelvic lymphadenectomy and of other possible risk factors on the complication rate was examined.Materials and Methods: All intraoperative and early postoperative complications in 1,380 patients who underwent radical retropubic prostatectomy were documented. Complications related to pelvic lymphadenectomy...
#1Agostino Mattei (University Hospital of Bern)H-Index: 19
#2Frank G. Fuechsel (University Hospital of Bern)H-Index: 4
Last. Urs E. Studer (University Hospital of Bern)H-Index: 85
view all 7 authors...
Abstract Objectives To map the primary prostatic lymphatic landing sites using a multimodality technique. Methods Thirty-four patients with organ-confined prostate cancer (cT1–cT2; cN0) underwent single-photon emission computed tomography fused with data from computed tomography (SPECT/CT) ( n =33) or magnetic resonance imaging (SPECT/MRI) ( n =1) 1h after ultrasound-guided intraprostatic injection of technecium (Tc-99m) nanocolloid. The presence of lymph nodes (LNs) containing Tc-99m was confir...
#1Willem Meinhardt (NKI-AVL: Netherlands Cancer Institute)H-Index: 20
Abstract Objectives Provide an overview of the use of the sentinel node (SN) technique in prostate carcinoma. The relevance of nodal staging in the several stages of prostate carcinoma, technical aspects of the SN technique, indications, and lessons learned from it are discussed. Introduction The lymph node status is relevant in all M0 tumour stages. In early prostate cancer the changes of nodal involvement are so low that invasive diagnostics are superfluous. However, the definition of this ear...
#1Tsuyoshi Yoshizawa (Nihon University)H-Index: 8
#2Nozomu Kawata (Nihon University)H-Index: 11
Last. Satoru Takahashi (Nihon University)H-Index: 36
view all 8 authors...
A case of primary urethral malignant melanoma of a 69-year-old Japanese woman is presented. A hemorrhagic tumor measuring 1 cm in diameter was diagnosed by the stamp method. Clinically, the primary lesion was a T4 tumor infiltrating to the bladder neck, vagina, and vulva. Computed tomography did not detect any inguinal lymph node swelling or metastases to other sites. We selected radical extirpation, including cystectomy, ureterostomy, and bilateral inguinal and pelvic lymph node dissection. Alt...
#1Stephen J. Savage (MUSC: Medical University of South Carolina)H-Index: 8
#2M. Scott Wingo (MUSC: Medical University of South Carolina)H-Index: 1
Last. Thomas E. Keane (MUSC: Medical University of South Carolina)H-Index: 32
view all 5 authors...
Laparoscopic port site metastases remain exceedingly rare for urologic tumors, despite the increasingly widespread use of laparoscopic techniques in the management of urologic malignancy. We report a case of port site metastases after transperitoneal laparoscopic radical prostatectomy.
#1Fernando J. Bianco (GW: George Washington University)H-Index: 51
#1Pierre I. Karakiewicz (UdeM: Université de Montréal)H-Index: 119
Cited By62
#1Rahul D. TendulkarH-Index: 21
#2Bindu V. ManyamH-Index: 8
Last. Omar MianH-Index: 1
view all 3 authors...
#1Daniela A. Ferraro (UZH: University of Zurich)H-Index: 9
#2Fabienne Lehner (UZH: University of Zurich)H-Index: 3
Last. Irene A. Burger (UZH: University of Zurich)H-Index: 30
view all 10 authors...
Positron emission tomography (PET) targeting the prostate-specific membrane antigen (PSMA) has superior sensitivity over conventional imaging (CI) to stage prostate cancer (PCa) and therefore is increasingly used in staging to stratify patients before radical therapy. Whether this improved diagnostic accuracy translates into improved outcome after radical prostatectomy (RPE) has not yet been shown. Therefore, the aim of this study was to compare the oncological outcome after RPE between patients...
#1Daniela A. Ferraro (UZH: University of Zurich)H-Index: 9
#2Jan H. Rüschoff (UZH: University of Zurich)H-Index: 13
Last. Irene A. Burger (UZH: University of Zurich)H-Index: 30
view all 11 authors...
Prostate-specific membrane antigen (PSMA) targeted PET has a high detection rate for biochemical recurrence (BCR) of prostate cancer (PCa). Nevertheless, even at high prostate-specific antigen (PSA) levels (> 3 ng/ml), a relevant number of PSMA-PET scans are negative, mainly due to PSMA-negative PCa. Our objective was to investigate whether PSMA-expression patterns of the primary tumour on immunohistochemistry (IHC) are associated with PSMA-PET detection rate of recurrent PCa. Methods: Retrospec...
Introduction Radical prostatectomy with extended pelvic lymph node dissection (ePLND) is a curative treatment option for patients with clinically significant localised prostate cancer. The decision to perform an ePLND can be challenging because the overall incidence of lymph node metastasis is relatively low and ePLND is not free of complications. Using current clinical nomograms to identify patients with nodal involvement, approximately 75–85% of ePLNDs performed are negative. The aim of this s...
#1Etienne Xavier Keller (UZH: University of Zurich)H-Index: 11
#2Jacqueline A. Bachofner (UZH: University of Zurich)H-Index: 3
Last. Cédric Poyet (UZH: University of Zurich)H-Index: 18
view all 12 authors...
Purpose To evaluate the prognostic value of positive surgical margins (PSM) focality for the prediction of biochemical recurrence (BCR) in patients undergoing robotic-assisted radical prostatectomy (RARP) for prostate cancer.
#1Stavros I. Tyritzis (KI: Karolinska Institutet)H-Index: 16
Last. N. Peter Wiklund (KI: Karolinska Institutet)H-Index: 30
view all 5 authors...
INTRODUCTION: The extent of lymph node dissection (LND) and its potential survival benefit are still a matter of debate. Aim of our review was to summarize the latest literature data regarding the surgical templates, the potential oncological benefits, the functional outcomes and the complications of extended lymph node dissection (eLND) during robot-assisted radical prostatectomy (RARP). EVIDENCE ACQUISITION: We systematically reviewed all relevant studies using PubMed, MEDLINE, Embase, America...
#1Jonathan Bloom (NYMC: New York Medical College)H-Index: 11
#2John Phillips (NYMC: New York Medical College)H-Index: 9
Nephroureterecomy represents the gold standard in surgical treatment of upper urinary tract urothelial carcinoma (UUT-UC). UUT-UC represents a highly aggressive disease with poor survival once invasive and high recurrence rates if the distal ureter and bladder cuff remain in place. This necessitates the need for urologists to make every attempt to remove the diseased tissue. While the basic principle of the nephroureterectomy surgery have remained the same, advances in technology have allowed su...
#1Russell Terry (UF: University of Florida)H-Index: 5
#2Mohit Gupta (UF: University of Florida)H-Index: 12
Last. Li-Ming Su (UF: University of Florida)H-Index: 41
view all 3 authors...
Robotic surgery represents a shift in the surgical paradigm and is consequently associated with a unique set of challenges and complications in comparison to open or conventional laparoscopic surgery. For the first time, the surgeon is not directly at the bedside but is rather directing an intermediary machine and a separate bedside team to perform the operation. This, in addition to the lack of tactile feedback, the greater reliance on visual anatomic clues when performing robotic surgery, and ...
#1Agostino MatteiH-Index: 19
Last. Hansjörg DanuserH-Index: 26
view all 5 authors...
Objective To describe a simplified technique of extended pelvic lymph node dissection (ePLND) for prostate cancer treated by robot-assisted radical prostatectomy (RARP). Materials and Methods The technique uses a standardized 10-step procedure to obtain a single tissue monoblock from each side that contains all lymph nodes within the ePLND template. We performed a prospective study of all patients with prostate cancer (n = 134) with a preoperative Gleason score of ≥7 and/or prostate-specific ant...
#1Ömer Acar (Koç University)H-Index: 11
#2Tarık Esen (Koç University)H-Index: 16
Prostate cancer is the second most common malignancy in men (excluding skin cancer) behind lung cancer, with more than one million cases estimated to be diagnosed worldwide in 2016. Radical prostatectomy (RP) has been the most widely used approach for the treatment of organ-confined prostate cancer. However, the high incidence of perioperative morbidities and functional derangements related with open radical retropubic prostatectomy (RRP) has led to the search for less invasive treatments to imp...
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.