EXTRAPERITONEAL LAPAROSCOPIC STAGING PELVIC LYMPH-NODE DISSECTION

Endoscopic lymph node dissection is preferred as the minimally invasive technique for lymph node staging of pelvic malignancies. Hald and Rasmussen first used mediastinoscopic techniques for lymph node sampling.(1) Querleu et al used the laparoscope to dissect pelvic lymph nodes in patients with cervical cancer.(2) Later, the laboratory work of Winfield et al(3) and the clinical report of Schuessler et al(4) established the use of laparoscopic lymph node dissection in the staging of prostate, bladder and penile cancer. The cumulative study of Kavoussi et al reported a 15% incidence of complications for 372 patients in whom intraperitoneal laparoscopic lymph node dissection was done.(5) Although some complications could be attributed to learning a new technique, certain risks of intraperitoneal Veress needle and trocar insertion, such as bowel or vascular injuries, are inherent with this procedure. Although the laparoscopic technique used by gynecologists to view pelvic organs was retained because it was expedient, our laparoscopic pelvic lymph node dissection method digressed from the established extraperitoneal approach to pelvic lymph nodes, which is the preferred route during open pelvic lymphadenectomy. We developed an extraperitoneal laparoscopic approach to staging pelvic lymphadenectomy, and discuss our technique and results.