Extended Pelvic Lymph Node Dissection in Robotic-assisted Radical Prostatectomy: Surgical Technique and Initial Experience

David S. Yee, Darren J. Katz, Guilherme Godoy, Lucas Nogueira, Kian Tai Chong, Matthew Kaag, Jonathan A. Coleman

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objectives: To describe, and show in the accompanying video segments, a technique for extended pelvic lymph node dissection (ePLND) in robotic-assisted radical prostatectomy (RARP) and report our clinicopathologic and perioperative outcomes. The extent of pelvic lymphadenectomy during radical prostatectomy has not been standardized. However, evidence demonstrates that an ePLND yields a greater number of positive nodes. Methods: A total of 32 patients with clinically localized prostate cancer underwent RARP with ePLND by a single surgeon (J.C.) between January and August 2008. The template for the ePLND included the obturator, hypogastric, external iliac, and common iliac lymph nodes up to the bifurcation of the aorta. Systematic review and grading of adverse events were performed. Results: The median number of lymph nodes retrieved was 18 (interquartile range [IQR] 12-28). Four patients (12.5%) had lymph node metastases. Of the 4 patients with lymph node metastases, 1 patient (25%) had the involved lymph node exclusively in the common iliac region. Median operative time for the ePLND was 72 minutes (IQR 66-86). Median hospital length of stay was 2.0 days (IQR 2.0-2.8). Graded complications included 13 grade 1 events and 1 grade 2 event, with 1 grade 1 event being considered related to ePLND. No clinically presenting lymphoceles or thrombotic events were encountered. Conclusions: An ePLND during RARP is technically feasible and appears to have minimal morbidity. It produces a high lymph node yield and may result in improved pathologic staging.

Original languageEnglish (US)
Pages (from-to)1199-1204
Number of pages6
JournalUrology
Volume75
Issue number5
DOIs
StatePublished - May 1 2010

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Robotics
Prostatectomy
Lymph Node Excision
Lymph Nodes
Length of Stay
Lymphocele
Neoplasm Metastasis
Operative Time
Aorta
Prostatic Neoplasms
Morbidity

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Yee, David S. ; Katz, Darren J. ; Godoy, Guilherme ; Nogueira, Lucas ; Chong, Kian Tai ; Kaag, Matthew ; Coleman, Jonathan A. / Extended Pelvic Lymph Node Dissection in Robotic-assisted Radical Prostatectomy : Surgical Technique and Initial Experience. In: Urology. 2010 ; Vol. 75, No. 5. pp. 1199-1204.
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abstract = "Objectives: To describe, and show in the accompanying video segments, a technique for extended pelvic lymph node dissection (ePLND) in robotic-assisted radical prostatectomy (RARP) and report our clinicopathologic and perioperative outcomes. The extent of pelvic lymphadenectomy during radical prostatectomy has not been standardized. However, evidence demonstrates that an ePLND yields a greater number of positive nodes. Methods: A total of 32 patients with clinically localized prostate cancer underwent RARP with ePLND by a single surgeon (J.C.) between January and August 2008. The template for the ePLND included the obturator, hypogastric, external iliac, and common iliac lymph nodes up to the bifurcation of the aorta. Systematic review and grading of adverse events were performed. Results: The median number of lymph nodes retrieved was 18 (interquartile range [IQR] 12-28). Four patients (12.5{\%}) had lymph node metastases. Of the 4 patients with lymph node metastases, 1 patient (25{\%}) had the involved lymph node exclusively in the common iliac region. Median operative time for the ePLND was 72 minutes (IQR 66-86). Median hospital length of stay was 2.0 days (IQR 2.0-2.8). Graded complications included 13 grade 1 events and 1 grade 2 event, with 1 grade 1 event being considered related to ePLND. No clinically presenting lymphoceles or thrombotic events were encountered. Conclusions: An ePLND during RARP is technically feasible and appears to have minimal morbidity. It produces a high lymph node yield and may result in improved pathologic staging.",
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Extended Pelvic Lymph Node Dissection in Robotic-assisted Radical Prostatectomy : Surgical Technique and Initial Experience. / Yee, David S.; Katz, Darren J.; Godoy, Guilherme; Nogueira, Lucas; Chong, Kian Tai; Kaag, Matthew; Coleman, Jonathan A.

In: Urology, Vol. 75, No. 5, 01.05.2010, p. 1199-1204.

Research output: Contribution to journalArticle

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T1 - Extended Pelvic Lymph Node Dissection in Robotic-assisted Radical Prostatectomy

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AU - Yee, David S.

AU - Katz, Darren J.

AU - Godoy, Guilherme

AU - Nogueira, Lucas

AU - Chong, Kian Tai

AU - Kaag, Matthew

AU - Coleman, Jonathan A.

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N2 - Objectives: To describe, and show in the accompanying video segments, a technique for extended pelvic lymph node dissection (ePLND) in robotic-assisted radical prostatectomy (RARP) and report our clinicopathologic and perioperative outcomes. The extent of pelvic lymphadenectomy during radical prostatectomy has not been standardized. However, evidence demonstrates that an ePLND yields a greater number of positive nodes. Methods: A total of 32 patients with clinically localized prostate cancer underwent RARP with ePLND by a single surgeon (J.C.) between January and August 2008. The template for the ePLND included the obturator, hypogastric, external iliac, and common iliac lymph nodes up to the bifurcation of the aorta. Systematic review and grading of adverse events were performed. Results: The median number of lymph nodes retrieved was 18 (interquartile range [IQR] 12-28). Four patients (12.5%) had lymph node metastases. Of the 4 patients with lymph node metastases, 1 patient (25%) had the involved lymph node exclusively in the common iliac region. Median operative time for the ePLND was 72 minutes (IQR 66-86). Median hospital length of stay was 2.0 days (IQR 2.0-2.8). Graded complications included 13 grade 1 events and 1 grade 2 event, with 1 grade 1 event being considered related to ePLND. No clinically presenting lymphoceles or thrombotic events were encountered. Conclusions: An ePLND during RARP is technically feasible and appears to have minimal morbidity. It produces a high lymph node yield and may result in improved pathologic staging.

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