With the increasing use of laparoscopic and robotic radical cystectomy (RC), there are perceived concerns about the adequacy of lymph node dissection (LND).
Describe the robotic and laparoscopic technique and the short-term outcomes of high extended pelvic LND (PLND) up to the inferior mesenteric artery (IMA) during RC.
Design, setting, and participants
From January 2007 through September 2009, we performed high extended PLND with proximal extent up to the IMA (n
We performed robotic extended PLND with the proximal extent up to the IMA or aortic bifurcation. The LND was performed starting from the right external iliac, obturator, internal iliac, common iliac, preaortic and para-aortic, precaval, and presacral and then proceeding to the left side. The accompanying video highlights our detailed technique.
Median age was 69 yr, body mass index was 26, and American Society of Anesthesiologists class ≥3 was present in 40% of patients. All urinary diversions, including orthotopic neobladder (n
Results and limitations
All 15 procedures were technically successful without need for conversion to open surgery. Median operative time was 6.7
High extended PLND during laparoscopic or robotic RC is technically feasible. Longer survival data in a larger cohort of patients are necessary to determine the proper place for robotic and laparoscopic surgery in patients undergoing RC for high-risk bladder cancer.
Keywords: Robotics, Laparoscopy, Pelvic lymph node dissection, Bladder cancer.
a USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
b Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
© 2011 Published by Elsevier B.V.