Laparoscopic radical prostatectomy and extended pelvic lymph node dissection: a combined technique

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Radical prostatectomy (RP) for high-risk (HR) prostate cancer necessitates extended pelvic lymph node dissection (ePLND).
• Standard ePLND is typically performed in two separate surgical stages, either pre- or transperitoneally.
• A combined approach may offer improved efficiency and safety.

Purpose of the Study:

• To present and evaluate a novel combined surgical technique for radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND).
• This technique utilizes a pre-peritoneal approach for laparoscopic radical prostatectomy (LRP) followed by a transperitoneal approach for ePLND.

Main Methods:

• A cohort of 30 prostate cancer patients (age 53-75) underwent the combined LRP and ePLND technique.
• The procedure involved a pre-peritoneal laparoscopic radical prostatectomy, followed by trocar repositioning into the peritoneal cavity for transperitoneal ePLND.
• Trocar transposition was a rapid maneuver, completed in under one minute without complications.

Main Results:

• The mean operative time was 215 minutes (range 155-290 min), with ePLND averaging 56 minutes (range 35-85 min).
• An average of 16.8 lymph nodes (range 13-28) were removed per patient.
• Positive surgical margins were observed in 16% of patients, and positive lymph nodes in 30%.

Conclusions:

• The combined pre-peritoneal LRP and transperitoneal ePLND technique is demonstrated to be feasible and safe.
• Performing the prostatectomy first may enhance operator comfort.
• The ePLND stage in this combined approach shows comparable outcomes to standard methods regarding timing and lymph node yield.