Laparoscopic Pelvic and Para-Aortic/Retroperitoneal Lymph Node Dissection

The application of laparoscopy in genitourinary surgery has broadened with recent advances in laparoscopic technique and instrumentation. Specifically, the laparoscopic pelvic lymph node dissection has become a viable alternative to open lymphadenectomy for the accurate staging of prostatic adenocarcinoma. The laparoscopic pelvic lymph node dissection is a less morbid method of determining nodal status and can potentially prevent a noncurative procedure in those patients with metastatic prostate cancer. Therefore, the laparoscopic pelvic lymph node dissection is limited to those patients with prostate cancer who have a high likelihood of metastatic disease as predicted by preoperative clinical staging, prostate-specific antigen, and Gleason grade. In contrast, the accuracy of the laparoscopic paraaortic/retroperitoneal lymph node dissection in the staging of nonseminomatous testis cancers has not yet been established. Although technically feasible, controversy over the increased morbidity and unproven accuracy of the laparoscopic retroperitoneal lymph node dissection exists when compared with its potentially curative, open counterpart. Therefore, the laparoscopic retroperitoneal lymph node dissection is performed only in those patients with nonseminomatous testis cancer who have a low likelihood of metastatic disease.