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Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases.
Eur Urol. 2009 Apr; 55(4):876-83.EU

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) > or = 10 ng/ml or a preoperative Gleason score > or = 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.

Authors+Show Affiliations

Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19101076

Citation

Feicke, Antje, et al. "Robotic-assisted Laparoscopic Extended Pelvic Lymph Node Dissection for Prostate Cancer: Surgical Technique and Experience With the First 99 Cases." European Urology, vol. 55, no. 4, 2009, pp. 876-83.
Feicke A, Baumgartner M, Talimi S, et al. Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases. Eur Urol. 2009;55(4):876-83.
Feicke, A., Baumgartner, M., Talimi, S., Schmid, D. M., Seifert, H. H., Müntener, M., Fatzer, M., Sulser, T., & Strebel, R. T. (2009). Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases. European Urology, 55(4), 876-83. https://doi.org/10.1016/j.eururo.2008.12.006
Feicke A, et al. Robotic-assisted Laparoscopic Extended Pelvic Lymph Node Dissection for Prostate Cancer: Surgical Technique and Experience With the First 99 Cases. Eur Urol. 2009;55(4):876-83. PubMed PMID: 19101076.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases. AU - Feicke,Antje, AU - Baumgartner,Martin, AU - Talimi,Scherwin, AU - Schmid,Daniel Max, AU - Seifert,Hans-Helge, AU - Müntener,Michael, AU - Fatzer,Markus, AU - Sulser,Tullio, AU - Strebel,Räto T, Y1 - 2008/12/13/ PY - 2008/09/29/received PY - 2008/12/04/accepted PY - 2008/12/23/entrez PY - 2008/12/23/pubmed PY - 2009/10/27/medline SP - 876 EP - 83 JF - European urology JO - Eur Urol VL - 55 IS - 4 N2 - 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) > or = 10 ng/ml or a preoperative Gleason score > or = 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. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/19101076/Robotic_assisted_laparoscopic_extended_pelvic_lymph_node_dissection_for_prostate_cancer:_surgical_technique_and_experience_with_the_first_99_cases_ DB - PRIME DP - Unbound Medicine ER -