title: Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature.
abstract: BACKGROUND
  Pelvic lymph node dissection (PLND) in prostate cancer is the most effective method for detecting lymph node metastases. However, a decline in the rate of PLND during radical prostatectomy (RP) has been noted. This is likely the result of prostate cancer stage migration in the prostate-specific antigen-screening era, and the introduction of minimally invasive approaches such as robot-assisted radical prostatectomy (RARP).
  
  
  OBJECTIVE
  To assess the efficacy, limitations, and complications of PLND during RARP.
  
  
  METHODS
  A review of the literature was performed using the Medline, Scopus, and Web of Science databases with no restriction of language from January 1990 to December 2012. The literature search used the following terms: prostate cancer, radical prostatectomy, robot-assisted, and lymph node dissection.
  
  
  RESULTS
  The median value of nodal yield at PLND during RARP ranged from 3 to 24 nodes. As seen in open and laparoscopic RP series, the lymph node positivity rate increased with the extent of dissection during RARP. Overall, PLND-only related complications are rare. The most frequent complication after PLND is symptomatic pelvic lymphocele, with occurrence ranging from 0% to 8% of cases. The rate of PLND-associated grade 3-4 complications ranged from 0% to 5%. PLND is associated with increased operative time. Available data suggest equivalence of PLND between RARP and other surgical approaches in terms of nodal yield, node positivity, and intraoperative and postoperative complications.
  
  
  CONCLUSIONS
  PLND during RARP can be performed effectively and safely. The overall number of nodes removed, the likelihood of node positivity, and the types and rates of complications of PLND are similar to pure laparoscopic and open retropubic procedures.
authors.affiliation: Department of Urology, Saint-Louis Hospital, APHP, Paris, France; Department of Urology, Jewish General Hospital and Montreal General Hospital, McGill University, Montreal, Canada; INSERM 955, Team 7, University Paris 12, Créteil, France. Electronic address: g.ploussard@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Ashutosh K
authors.initials: AK
authors.lastname: Tewari
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
mesh_terms: D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008297:Male; D010388:Pelvis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics
keywords: Lymph node dissection; Prostate cancer; Radical prostatectomy; Robot assisted