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)
Sources
Abstract
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.
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References34
Newest
#1Alberto BrigantiH-Index: 99
#2Umberto CapitanioH-Index: 63
Last. Patrizio RigattiH-Index: 89
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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...
Source
#1Michael K Eng (U of C: University of Chicago)H-Index: 5
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#1Martin C. Schumacher (University of Bern)H-Index: 14
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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...
Source
#1Michael MuschH-Index: 11
Last. Darko KroepflH-Index: 9
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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...
Source
#1Agostino Mattei (University Hospital of Bern)H-Index: 19
#2Frank G. Fuechsel (University Hospital of Bern)H-Index: 4
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#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
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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.
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#1Fernando J. Bianco (GW: George Washington University)H-Index: 51
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