title: Open versus laparoscopic retroperitoneal lymph node dissection: assessing adequacy of dissection in a porcine model.
abstract: OBJECTIVE
  Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is emerging as a viable alternative to traditional open retroperitoneal lymph node dissection (O-RPLND). Despite numerous reports confirming clinical oncologic equivalency between the two approaches, however, concerns still remain over the adequacy of laparoscopic dissection. We therefore sought to compare the completeness of dissection between O-RPLND and L-RPLND in a porcine model.
  
  
  METHODS
  Fourteen domestic swine were divided into two equivalent groups. Both groups underwent bilateral retroperitoneal lymph node dissection, approximating templates used in human dissection. In one group, the procedure was performed through an open midline incision, while the other group underwent completely laparoscopic dissection. Tissue was independently analyzed by a pathologist, who recorded lymph node yield based on microscopic evaluation.
  
  
  RESULTS
  All animals in the L-RPLND group underwent successful procedures, without the need for conversion. Two open procedures were aborted because of hemorrhage. Mean lymph node yield from O-RPLND was 32, while the mean yield for L-RPLND was 29. This difference was not statistically significant (P=0.65).
  
  
  CONCLUSIONS
  In the porcine model, L-RPLND is capable of providing a quality of dissection equivalent to that of O-RPLND, in terms of absolute lymph node yield on microscopic examination. The applicability of this data to human patients, however, may be limited by significant anatomic differences between the human and the pig. Further prospective comparison in human patients is critically needed.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. benwayb@wudosis.wustl.edu
authors.forename: Brian M
authors.initials: BM
authors.lastname: Benway
authors.forename: Dilmer L
authors.initials: DL
authors.lastname: Diaz
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Katz
authors.forename: Itay Y
authors.initials: IY
authors.lastname: Vardi
authors.forename: Naeem T
authors.initials: NT
authors.lastname: Chavla
authors.forename: Alana C
authors.initials: AC
authors.lastname: Desai
authors.forename: Khalid H
authors.initials: KH
authors.lastname: Badwan
authors.forename: Keegan L
authors.initials: KL
authors.lastname: Maxwell
authors.forename: Geneva
authors.initials: G
authors.lastname: Baca
authors.forename: Peter A
authors.initials: PA
authors.lastname: Humphrey
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D000818:Animals; D002452:Cell Count; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000166:cytology / Q000601:surgery; D023421:Models, Animal; D012187:Retroperitoneal Space / Q000601:surgery*; D034421:Sus scrofa