title: Laparoscopic extended pelvic lymphadenectomy for bladder cancer: technique and initial outcomes.
abstract: OBJECTIVE
  We describe the technique and our evolving outcomes of laparoscopic extended pelvic lymphadenectomy for bladder cancer.
  
  
  METHODS
  Since 1999 laparoscopic radical cystectomy with pelvic lymphadenectomy and intracorporeal urinary diversion has been performed in 22 patients. The initial 11 patients underwent limited dissection (group 1) and the subsequent 11 consecutive patients underwent extended lymphadenectomy (group 2). Our split-and-roll technique of laparoscopic extended pelvic lymphadenectomy has evolved to achieve lymphatic tissue clearance by bilaterally skeletonizing the genitofemoral nerve, external iliac artery, external iliac vein, obturator nerve, hypogastric artery, common iliac artery and pubic bone.
  
  
  RESULTS
  Extended lymphadenectomy added 1.5 hours of operative time. The median number of nodes retrieved was 3 and 21 in groups 1 and 2, respectively (p = 0.001). Three patients per group were found to have positive nodal disease. In 1 patient undergoing extended dissection injury to a deep pelvic vein was managed by intracorporeal suturing and resulted in 200 ml blood loss. Two other patients had deep venous thrombosis. At a mean followup of 11 months (range 2 to 43) there were no port site recurrences.
  
  
  CONCLUSIONS
  Laparoscopic extended pelvic lymphadenectomy for bladder cancer can be performed with anatomical boundaries and nodal yields commensurate with those of current recommendations for open surgery.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Alireza
authors.initials: A
authors.lastname: Moinzadeh
authors.forename: Cristina
authors.initials: C
authors.lastname: Magi-Galluzzi
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D010388:Pelvis; D001749:Urinary Bladder Neoplasms / Q000601:surgery*