Prophylactic laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: remarking on the vesicohypogastric fascia.
OBJECTIVE
To introduce the prophylactic laparoscopic lateral pelvic lymph node dissection performing by remarking the vesicohypogastric fascia following total mesorectal excision for patients with advanced lower rectal cancer without radiological evidence of lymph node involvement.


METHODS
We set 5 ports for conventional laparoscopic rectal surgery. During the prophylactic laparoscopic lateral pelvic lymph node dissection, we retrieved the lymph nodes from the internal iliac area and obturator area. We recognized the pelvic nerve plexus, vesicohypogastric fascia (including internal iliac vessels), and parietal fascia (psoas muscle fascia, pubic bone and internal obturator muscle fascia) as the dissection borders from internal to external. Of note, the vesicohypogastric fascia can be recognized under magnified clear vision, and can be preserved by precise dissection, resulting in reduced hemorrhage from the internal iliac vessels and complications such as urinary dysfunction.


CONCLUSIONS
Prophylactic laparoscopic lateral pelvic lymph node dissection after remarking on the vesicohypogastric fascia may contribute to a less invasive surgery compared with conventional laparoscopic lateral pelvic lymph node dissection.
Dept. of Surgery, Nara Medical University.
Takeshi
T
Ueda
Fumikazu
F
Koyama
Tadashi
T
Nakagawa
Shinji
S
Nakamura
Naoto
N
Nishigori
Takashi
T
Inoue
Keijiro
K
Kawasaki
Shinsaku
S
Obara
Takayuki
T
Nakamoto
Kazuaki
K
Uchimoto
Hisao
H
Fujii
Yoshiyuki
Y
Nakajima
D000071938:Fasciotomy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000517:prevention & control; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*