Template-based pelvic lymph node dissection during lateral decubitus-positioned total retroperitoneal laparoscopic
Jun-Wei Pan1, Xiang Zhang1, Xue-Jian Zhou1
1Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The template-based pelvic lymph node dissection (PLND) technique is an essential part of the radical nephroureterectomy (RNU) technical system. Recently, the lateral decubitus-positioned total retroperitoneal laparoscopic radical nephroureterectomy (LTRL-RNU) has been introduced. Here, we present a lateral decubitus-positioned laparoscopic PLND technique for this novel technical system.
Methods:
From July 2022 to September 2024, 11 patients with high-risk distal upper tract urothelial cancer (UTUC) underwent PLND during LTRL-RNU. All the surgical procedures were performed under a caudal view by the same surgeon. The surgery needed 0-1 additional trocars. The separation was practiced along the psoas muscle on the dorsal side of the external iliac artery and external iliac vein until the obturator nerve was exposed. Then, the obturator nerve, the common iliac artery, the external iliac artery and the external iliac vein were skeletonized, and the lymphatic adipose tissue was dissected. The basic characteristics and surgical outcomes were retrospectively analyzed.
Results:
The mean operation time for RNU was 142.55±40.94 min, and the mean time for PLND was 31.18±8.62 min. Three to five trocars were used for the whole procedure, and 0.40±0.50 additional trocars were used for PLND. The only complication noted was one case of mild anemia (Clavien-Dindo grade I) without transfusion. One patient had severe scoliosis, two had external iliac artery tortuosity, one had common iliac artery tortuosity, and one patient experienced inferior vena cava tumor thrombus (Mayo Clinic Grading System grade I). The success rate of the surgery was 100%, and the pathological positive rate of PLND was 9.09%.
Conclusions:
PLND under LTRL-RNU is feasible, and its inclusion may allow lateral decubitus-positioned retroperitoneal laparoscopy to become a standard approach for treating distal UTUC.
