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Updated: May 14, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Standardized and simplified extended pelvic lymph node dissection during robot-assisted radical prostatectomy: the
Agostino Mattei1, Giovanni Battista Di Pierro, Pietro Grande
1Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. agomat@gmx.ch
Objective:
To describe a simplified technique of extended pelvic lymph node dissection (ePLND) for prostate cancer treated by robot-assisted radical prostatectomy (RARP).
Materials And Methods:
The technique uses a standardized 10-step procedure to obtain a single tissue monoblock from each side that contains all lymph nodes within the ePLND template. We performed a prospective study of all patients with prostate cancer (n = 134) with a preoperative Gleason score of ≥ 7 and/or prostate-specific antigen level >10 ng/mL undergoing ePLND before RARP using transperitoneal access at our institute from July 2008 to August 2011. The standardized procedure consisted of 10 distinct surgical steps. Dissection obtained all lymph nodes and surrounding fatty tissue in a single monoblock applying the following ePLND template: cranially, the ureter crossing the common iliac artery; caudally, the femoral canal; laterally, the medial border of the external iliac artery; and medially, the medial border of the hypogastric artery. The number of resected lymph nodes and postoperative ePLND-related complications according to the modified Clavien classification were documented.
Results:
The median number of resected lymph nodes was 14 (interquartile range 11-19). Complications related to ePLND were seen in 8 patients (5.9%).
Conclusion:
The robot-assisted monoblock ePLND technique is simple to perform, offers a good overview of the operative field during the entire procedure, permits complete and radical removal of the lymphatic tissue contained in the ePLND template, and avoids spreading of fatty and lymphatic tissue within the abdominal cavity.
