Advertisement

Laparoscopic and Robotic Pelvic Lymphadenectomy

  • Vincent G. Bird
  • Howard N. Winfield
Part of the Current Clinical Urology book series (CCU)

Abstract

In 1991, Schuessler et al. first reported the application of laparoscopic pelvic lymph node dissection (L-PLND) for staging of adenocarcinoma of the prostate (1). Subsequently, laparoscopic-limited obturator PLND, and in select cases, extended obturator and iliopsoas node dissection, has become the primary initial application of urologic laparoscopic surgery as a diagnostic and therapeutic technique (2). Follow-up studies on L-PLND clearly indicated that this procedure was comparable in accuracy and significantly less morbid than open PLND (Table 1) (3–6). While early studies showed a longer operative time for L-PLND, they also demonstrated a significant reduction in postoperative pain, hospitalization, and convalescence compared with open PLND (3–5). As expected, L-PLND initially showed an increased overall cost. However, with gradual refinements of technique, reusable equipment, and a reduced need for specialized instrumentation, overall cost is now likely to be equivalent to or less than open PLND (7–9). More recently, robot-assisted L-PLND has been performed in conjunction with robot-assisted laparoscopic radical prostatectomy, both by the transperitoneal and extraperitoneal routes. The cost effectiveness of this procedure is unclear in light of the need for significant capital investment in the robotic device, its maintenance, and the ongoing need for limited reusable accessories.

Keywords

Radical Prostatectomy Iliac Artery Common Iliac Artery External Iliac Artery Pubic Bone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Schuessler WW, Vancaille TG, Reich H, et al.: Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer. J Urol 145:988–991, 1991.PubMedGoogle Scholar
  2. 2.
    Griffith DP, Schuessler WW, Vancaille TH: Laparoscopic lymphadenectomy-a low morbidity alternative for staging pelvic malignancies. J Endourol 4 (Suppl 1):S-84, 1990.Google Scholar
  3. 3.
    Winfield HN, Donovan JF, See WA, et al.: Laparoscopic pelvic lymph node dissection for genitourinary malignancies: Indications, techniques, and results. J Endourol 6:103–111, 1992.CrossRefGoogle Scholar
  4. 4.
    Kerbl K, Clayman RV, Petros J, et al.: Staging pelvic lymphadenectomy for prostate cancer: A comparison of laparoscopic and open techniques. J Urol 150:396–399, 1993.PubMedGoogle Scholar
  5. 5.
    Parra RO, Andrus C, Boullier J, et al.: Staging laparoscopic pelvic lymph node dissection: comparison of result with open pelvic lymphadenectomy. J Urol 147:875–878, 1992.PubMedGoogle Scholar
  6. 6.
    Winfield HN, See WA, Donovan JF, et al.: Comparative effectiveness and safety of laparoscopic vs open pelvic lymph node dissection for cancer of the prostate. J Urol 147:244A, 1992.Google Scholar
  7. 7.
    Winfield HN, Donovan JF, Troxel SA, et al.: Laparoscopic urologic surgery: the financial realities. Surg Oncol Clin North Am 4:307–314, 1995.Google Scholar
  8. 8.
    Troxel S, Winfield HN: Comparative financial analysis of laparoscopic versus open pelvic lymph node dissection for men with cancer of the prostate. J Urol 151:675–680, 1994.PubMedGoogle Scholar
  9. 9.
    Kozlowski PM, Winfield HN: Laparoscopic lymph node dissection: pelvic and retroperitoneal. Semin Laparosc Surg 7:150–159, 2000.CrossRefPubMedGoogle Scholar
  10. 10.
    Winfield HN, Schuessler WW: Pelvic lymphadenectomy: limited and extended. In: Clayman RV, McDougall EM (eds): Laparoscopic Urology. St. Louis: Quality Medical Publishing, 1993; pp 225–259.Google Scholar
  11. 11.
    Winfield HN: Laparoscopic pelvic lymph node dissection for urologic pelvic malignancies. Atlas Urol Clin North Am 1:33–47, 1993.Google Scholar
  12. 12.
    Shackley DC, Irving SO, Brough WA, O'Reilly PH: Staging laparoscopic pelvic lymphadenectomy in prostate cancer. BJU Int 83: 260–264, 1999.CrossRefPubMedGoogle Scholar
  13. 13.
    Kavoussi LR, Sosa E, Chandhoke P, et al.: Complications of laparoscopic pelvic lymph node dissection. J Urol 149:322–325, 1993.PubMedGoogle Scholar
  14. 14.
    Winfield HN: Laparoscopic pelvic lymph node dissection for urologic malignancies. In: Gomella LG, Kozminski M, Winfield HN, (eds): Laparoscopic Urologic Surgery. New York: Raven Press, 1994; pp 111–130.Google Scholar
  15. 15.
    Hua JC, Nelson RA, Wilson TG et al.: Perioerative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy. J Urol 175(2), 541–546, 2006.CrossRefGoogle Scholar
  16. 16.
    Glascock JM, Winfield HN: Pelvic lymphadenectomy: intra- and extraperitineal access. In Smith AD, Badlani GH, Bagley DH, et al. (eds): Smith’s Textbook of Endourology. St. Louis: Quality Medical Publishing, 1996; pp 870–893.Google Scholar
  17. 17.
    Glascock JM, Winfield HN, Lund GO, et al.: Carbon dioxide homeostasis during trans- or extraperitoneal laparoscopic pelvic lymphadenectomy: a real time intraoperative comparison. J Endourol 10:319–323, 1996.CrossRefPubMedGoogle Scholar
  18. 18.
    Winfield HN, Lund GO: Extraperitoneal laparoscopic surgery: creating a working space. Contemp Urol 7:17–22, 1995.Google Scholar
  19. 19.
    Golimbu M, Morales P, Ali-Askari S, et al.: Extended pelvic lymphadenectomy for prostate cancer. J Urol 121: 617–620, 1979.PubMedGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC, a part of Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Vincent G. Bird
    • 1
  • Howard N. Winfield
    • 2
  1. 1.Department of UrologyUniversity of Miami Leonard Miller School of MedicineMiamiUSA
  2. 2.Invasive Urologic SurgeryUniversity of IowaIowa CityUSA

Personalised recommendations