Robotic-Assisted Laparoscopic Extended Pelvic Lymph Node Dissection for Prostate Cancer: Surgical Technique and Experience with the First 99 Cases

Abstract Background To date, there is still a paucity of data in the literature on robotic-assisted laparoscopic extended pelvic lymph node dissection (RALEPLND) in patients with prostate cancer. Objective To assess the technical feasibility of RALEPLND and to present our surgical technique. Design, setting, and participants From April 2006 to March 2008, we performed RALEPLND in 99 patients prior to robotic-assisted laparoscopic radical prostatectomy. Indications for RALEPLND were a prostate-specific antigen (PSA) ≥10 ng/ml or a preoperative Gleason score ≥7. The data were evaluated retrospectively. Surgical procedure The transperitoneal approach was used in all cases. In order to gain optimal access to the common iliac bifurcation, the five trocars were placed in a more cephalad position than in patients undergoing radical prostatectomy without RALEPLND. After identification of important landmarks, the lymphatics covering the external iliac vein, the obturator lymphatic packet, and the lymphatics overlying the internal iliac artery were removed on both sides. Measurements The total lymph node yield, the frequency of lymph node metastases, and the complication rate. Results and limitations The median patient age was 64 yr (range: 45–78). The median preoperative PSA level was 7.7 ng/ml (range: 1.5–84.6). The median number of lymph nodes harvested was 19 (range: 8–53). In 16 patients (16%), we found lymph node metastasis. Complications occurred in seven patients (7%). Conclusions RALEPLND is feasible, and its lymph node yield is well in the range of open series. The robotic-assisted laparoscopic approach in itself does not seem to limit a surgeon's ability to perform a complete extended pelvic lymph node dissection.