title: Extended pelvic lymph node dissection in robotic-assisted radical prostatectomy: surgical technique and initial experience.
abstract: OBJECTIVE
  To describe, and show in the accompanying video segments, a technique for extended pelvic lymph node dissection (ePLND) in robotic-assisted radical prostatectomy (RARP) and report our clinicopathologic and perioperative outcomes. The extent of pelvic lymphadenectomy during radical prostatectomy has not been standardized. However, evidence demonstrates that an ePLND yields a greater number of positive nodes.
  
  
  METHODS
  A total of 32 patients with clinically localized prostate cancer underwent RARP with ePLND by a single surgeon (J.C.) between January and August 2008. The template for the ePLND included the obturator, hypogastric, external iliac, and common iliac lymph nodes up to the bifurcation of the aorta. Systematic review and grading of adverse events were performed.
  
  
  RESULTS
  The median number of lymph nodes retrieved was 18 (interquartile range [IQR] 12-28). Four patients (12.5%) had lymph node metastases. Of the 4 patients with lymph node metastases, 1 patient (25%) had the involved lymph node exclusively in the common iliac region. Median operative time for the ePLND was 72 minutes (IQR 66-86). Median hospital length of stay was 2.0 days (IQR 2.0-2.8). Graded complications included 13 grade 1 events and 1 grade 2 event, with 1 grade 1 event being considered related to ePLND. No clinically presenting lymphoceles or thrombotic events were encountered.
  
  
  CONCLUSIONS
  An ePLND during RARP is technically feasible and appears to have minimal morbidity. It produces a high lymph node yield and may result in improved pathologic staging.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. yeed1@mskcc.org
authors.forename: David S
authors.initials: DS
authors.lastname: Yee
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Katz
authors.forename: Guilherme
authors.initials: G
authors.lastname: Godoy
authors.forename: Lucas
authors.initials: L
authors.lastname: Nogueira
authors.forename: Kian Tai
authors.initials: KT
authors.lastname: Chong
authors.forename: Matthew
authors.initials: M
authors.lastname: Kaag
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Coleman
mesh_terms: D000368:Aged; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics