Extended pelvic lymph node dissection during extraperitoneal laparoscopic or robotic assisted radical prostatectomy

Iason Kyriazis, Evangelos Liatsikos, Jens Uwe Stolzenburg


Objective: Extraperitoneal access in endoscopic (laparoscopicic
or robotic assisted) radical prostatectomy is a standard approach
in the management of prostatic cancer with well-established
advantages over transperitoneal access. Still, traditionally, extraperitoneal
endoscopic radical prostatectomy (EERP) has been
associated with an inability to offer an extended pelvic lymph
node dissection (PLND). The former is due to the fact that in the
extraperitoneal space, peritoneal folding covers the majority of
common iliac vessels and as a result in extraperitoneal PLND,
lymph nodes (LNs) located above the bifurcation of common iliac
vessels cannot be dissected. We herein present a simple and easy
technique to offer an extended PLND during EERP.
Methods: After a conventional extraperitoneal PLND, a peritoneal
fenestration cranially to extrernal iliac vessels is performed
bilaterally exposing the common iliac vessels.
Results: Upon peritoneal fenestration, PLND can be continued
in a standard fashion as in transperitoneal approach until the
uppermost limit of the extended PLND template which is the
ureteral crossing over common iliac vessels. Following LN dissection,
both peritoneal fenestrations are left open at both sides,
as this approach has been found to decrease the incidence of
postoperative lymphocele formation.
Conclusions: Peritoneal fenestration over common iliac vessels
during extraperitoneal PLND is an easy approach that allows
surgeon to reach the uppermost limit of extended PLND template.
The latter peritoneal dissection is not time consuming and is
expected to decrease the morbidity of the operation reducing
the incidence of postoperative lymphocele formation.


extraperitoneal; pelvic lymph node dissection; radical prostatectomy; prostate cancer

Full Text:



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DOI: http://dx.doi.org/10.19264/hj.v31i2.270