Laparoscopic extended pelvic lymph node dissection during radical cystectomy: technique and clinical outcomes

• To study the surgical techniques and clinical results of laparoscopic extended pelvic lymph node dissection during radical cystectomy.

• From July 2007 to October 2009, 43 patients with bladder carcinoma received laparoscopic radical cystectomy with extended pelvic lymphadenectomy and urinary diversion. • Pelvic lymph node dissection (PLND) was first performed within extended template. • The lower part of aorta and vena cava were isolated from the bifurcation of common iliac artery to the level of the inferior mesenteric artery. • The standard template PLND was continued along the external iliac vessels, internal iliac vessels and obturator nerve. The bladder was then removed laparoscopically and urinary diversion was performed.

• All procedures were performed successfully and no open conversion occurred. The duration of the procedure for extended PLND was 90-185 min (mean 125 min) and total duration was 280-470 min (mean 329 min). • Intra-operative blood loss was 200-1500 mL (mean 325 mL) and eight cases received transfusion. Pathological study identified transitional cell carcinoma and a negative margin in all cases. A range of 19-53 lymph nodes were dissected in the patients with a mean of 31.3. • In total, 17 positive nodes were confirmed in 11 cases. Postoperative complications included two cases of bowel obstruction, two cases of mild urine leakage and 17 cases of lymphatic leakage.

• Laparoscopic radical cystectomy with extended pelvic lymphadenectomy is indicated in selected patients with bladder cancer. • It is safe, minimally invasive and more lymph nodes can be retrieved with a higher success rate by extended pelvic lymphadenectomy.