Korean J Urol.  2009 Sep;50(9):870-878.

The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy

• Kang SC
• Kang SG
• Choi H
• Ko YH
• Lee JG
• Kim JJ
• Kang SH
• Cheon J

Abstract

PURPOSE
We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. MATERIALS AND METHODS: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. RESULTS: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5+/-145.1 minutes, and the mean estimated blood loss was 346.8+/-205.9 ml. The mean time for PLND was 106.7+/-25.2 minutes in patients with ePLND and 72.1+/-14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23.5+/-12.8 (range, 8-50) in all patients: 38.6+/-10.8 (range, 29-50) in ePLND and 15.7+/-12.2 (range, 8-21) in sPLND. CONCLUSIONS: Perioperative data and oncologic features showed that RARC with PLND is feasible. Robot-assisted laparoscopic surgery is a safe and effective procedure with acceptable morbidity and good oncologic results from the viewpoint of PLND, especially ePLND.

Keyword

Urinary bladder neoplasms; Lymphadenectomy; Robotics; Cystectomy; Laparoscopy

MeSH Terms

Cystectomy
Humans
Korea
Laparoscopy
Linear Models
Lymph Node Excision
Lymph Nodes
Operative Time
Prospective Studies
Robotics
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  Fig. 1 The port placement for RARC with PLND. (A) Port sites and incisions for extracorporeal urinary diversions. All trocars, except for one assistant port, are placed on a concentric line from the umbilicus. (B) Port placement before docking of the robotic instrument. RARC: robot-assisted laparoscopic radical cystectomy, PLND: pelvic lymph node dissection.

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  Fig. 2 Landmark of extended pelvic lymph node dissection. (A) Genitofemoral nerve to external iliac artery, (B) obturator nerve, (C) inferior mesenteric artery and aortic bifurcation.

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  Fig. 3 Lymph node yield (LNY) curve: The patients in the extended pelvic lymph node dissection (ePLND) group had a larger LNY than did the patients in the standard PLND group.

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