Abstract
Lateral pelvic lymph node dissection for treatment of advanced low rectal cancer has been predominantly performed in Japan, because of technical difficulties and higher incidence of surgical morbidities. In our institution, for patients with advanced low rectal cancer and synchronous clinically positive pelvic lateral nodes, treatment has included preoperative concurrent chemoradiation therapy (CCRT) followed by total mesorectal excision (TME). However, for patients with persistent enlargement of lymph node(s) even after CCRT, we have selectively performed lateral pelvic lymph node dissection. This procedure by a minimally invasive approach, either using laparoscopic or robotic technique, has been rarely reported. In this chapter, we present our lateral pelvic lymph node dissection approach for patients with clinically positive lateral node(s) after preoperative CCRT.
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In this video, we demonstrate our routinized robotic LPLND surgical procedures. In this procedure, we commenced the clearance of lymphatic tissues by dissection of the common iliac vessels. The obturator fossa was then entered from the bifurcation of the internal and external iliac vessels. The lymphatic chains, intermingled with adipose tissues within the obturator fossa and paravesical fossa, were dissected with the intent of en bloc removal. However, when the lymph node packet was broken during the dissection process, some of the lymph nodes were inevitably retrieved individually. Generally, when a patient requires abdominal perineal resection, LPLND was performed during the interim period, which is after full downward mobilization of the mesorectum to the pelvic floor and before perineal excision of the anorectum. When bilateral LPLND is necessary, we routinely re-dock the robot to the opposite station to facilitate a better approach to the lateral pelvic lymph nodes (MP4 180560 kb)
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Liang, JT. (2020). Minimally Invasive Lateral Pelvic Lymph Node Dissection. In: Kim, J., Garcia-Aguilar, J. (eds) Minimally Invasive Surgical Techniques for Cancers of the Gastrointestinal Tract. Springer, Cham. https://doi.org/10.1007/978-3-030-18740-8_31
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DOI: https://doi.org/10.1007/978-3-030-18740-8_31
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