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

Piotr Jarzemski; Slawomir Listopadzki; Piotr Słupski; Marcin Jarzemski; Bartosz Brzoszczyk; Roman Sosnowski

doi:10.5114/wiitm.2019.86810

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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abstract:

Original paper

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

Piotr Jarzemski

¹

,

Slawomir Listopadzki

¹

,

Piotr Słupski

¹

,

Marcin Jarzemski

¹

,

Bartosz Brzoszczyk

¹

,

Roman Sosnowski

²

Department of Urology, Jan Biziel University Hospital in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
Department of Urooncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

Videosurgery Miniinv 2020; 15 (1): 192–198

DOI: https://doi.org/10.5114/wiitm.2019.86810

Online publish date: 2020/02/02

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Introduction
The important part of radical prostatectomy (RP) for high risk (HR) is extended pelvic lymph node dissection (ePLND). This method consists of two stages of surgery usually performed at the compartment (pre- or transperineally).

Aim
We present our new combined technique of RP using two different approaches: a pre-peritoneal approach for laparoscopic radical prostatectomy (LRP) and a transperitoneal approach for ePLND.

Material and methods
This study included 30 patients aged 53 to 75 years (mean age: 64 years) with prostate cancer who underwent LRP and ePLND using a combined technique. After the pre-peritoneal LRP, transposition of the trocars into the peritoneal cavity was performed without changing their location, except the extreme left trocar, which was inserted through a new approach.

Results
The total duration of surgery was 155 to 290 min (mean: 215 min); ePLND lasted from 35 to 85 min (mean: 56 min). The movement of trocars into the peritoneal cavity was a very simple maneuver, taking up to 1 min without any complications. The number of removed lymph nodes (LNs) ranged from 13 to 28 (mean: 16.8). A positive margin was found in 5 (16%) patients. We recognized positive nodes in 9 (30%) patients.

Conclusions
The combined technique is both feasible and safe. Performing the most difficult maneuver, removal of the prostate, in the first stage appears to be more comfortable for the operator. The timing of the PLND stage in the combined technique and the number of removed LNs do not differ from the standard lenticular access.

keywords:

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

Piotr Jarzemski 1 , Slawomir Listopadzki 1 , Piotr Słupski 1 , Marcin Jarzemski 1 , Bartosz Brzoszczyk 1 , Roman Sosnowski 2

laparoscopy, prostate cancer, lymph node dissection

Piotr Jarzemski

¹

,

Slawomir Listopadzki

¹

,

Piotr Słupski

¹

,

Marcin Jarzemski

¹

,

Bartosz Brzoszczyk

¹

,

Roman Sosnowski

²