Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection

Bae, Jung Hoon; Koh, Wooree; Kim, Hyun Ho; Lee, Yoon Suk

doi:10.3393/ac.2020.08.05

Cited by 8 publications

(14 citation statements)

References 6 publications

(2 reference statements)

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“…Some colorectal surgeons have referred to the UHF in the context of lateral pelvic LN dissection 15,16 . This procedure enables preservation of the pelvic plexus and splanchnic autonomic nerves.…”

Section: Discussionmentioning

confidence: 99%

“…Some colorectal surgeons have referred to the UHF in the context of lateral pelvic LN dissection. 15,16 This procedure enables preservation of the pelvic plexus and splanchnic autonomic nerves. Transient neurogenic dysuria was observed in three patients; however, they recovered within 1 month.…”

Section: Surgery By Internal Ileusmentioning

confidence: 99%

“…13,14 Colorectal surgeons are familiar with this structure, and this surgical plane has shown utility for lateral LN dissection in rectal cancer. 15,16 Preservation of the pelvic plexus and pelvic splanchnic nerves while approaching the vesical arteries is possible in this plane. However, few urological reports have described "development" of the UHF during ePLND for PC.…”

Section: Introductionmentioning

confidence: 99%

“…The uretero‐hypogastric nerve fascia (UHF) is the thin connective tissue layer covering the hypogastric nerve and ureter 13,14 . Colorectal surgeons are familiar with this structure, and this surgical plane has shown utility for lateral LN dissection in rectal cancer 15,16 . Preservation of the pelvic plexus and pelvic splanchnic nerves while approaching the vesical arteries is possible in this plane.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Simplified approach to the medial internal iliac region using a uretero‐hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot‐assisted radical prostatectomy for high‐risk prostate cancer

et al. 2022

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Introduction Although several clinical guidelines for prostate cancer (PC) recommend extended pelvic lymph node dissection (ePLND) during radical prostatectomy for high‐risk cases, there are several issues to consider, including certain technical aspects. A simplified approach to the medial internal iliac region and paravesical arteries has not been established. The uretero‐hypogastric nerve fascia (UHF) envelopes the ureter, hypogastric nerve, and pelvic autonomic nerves. To preserve the UHF, it is possible to approach the medial side of the internal iliac vessels without injuring any important tissue. We analyzed technical feasibility and lymph node (LN) yields. Patients and methods After obtaining institutional review board approval, 265 high‐risk PC patients with ePLND were identified. A da Vinci S or Xi robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used. We divided the patients into conventional (non‐UHF) method and modified (UHF) groups. The numbers of LNs removed, procedure‐related complications, and surgical outcomes were analyzed. Results The median number of LNs removed was 19.0 in the non‐UHF group and 22.0 in the UHF group (p = 0.004). Significantly more LNs were removed from the internal iliac region in the UHF group (p = 0.042). There was no difference in overall operative, console, or LN dissection time, or the severe complication rate (Clavien‐Dindo grade ≥ III), between the non‐UHF and UHF groups. Conclusions Our simplified approach using the UHF development technique is technically feasible, has no major complications, and allows for the removal of significantly more LNs compared with the conventional method.

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Section: Discussionmentioning

confidence: 99%

Section: Surgery By Internal Ileusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Simplified approach to the medial internal iliac region using a uretero‐hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot‐assisted radical prostatectomy for high‐risk prostate cancer

et al. 2022

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“…A series of RCTs from various centers worldwide, along with numerous retrospective studies over the past 20 years of clinical practice, have presented unified results of comparable survival outcomes of robot-assisted rectal cancer surgery with laparoscopic surgery (Table 1) [17][18][19][20][21]. Confidence from accumulated experience has led to the adaption of robotic surgery to even more complicated and advanced cases of rectal cancer [22][23][24][25][26].…”

Section: Rectal Cancermentioning

confidence: 99%

Robot-Assisted Colorectal Surgery

Kim¹

2022

Ewha Med J

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Minimally invasive surgery for colorectal disease has now become the standard treatment in Republic of Korea. However, there are limitations to the laparoscopic approach, such as an unstable camera support, a limited range of motion, and poor ergonomics. Recent advances in technology have led to the introduction of robotic surgical systems in colorectal surgery to overcome these shortcomings. Robot-assisted colorectal surgery has clear advantages in many aspects. Surgery involving the rectum benefits the most among colorectal diseases owing to technical difficulties in rectum dissection. The concept of robotic surgery is not different from laparoscopic surgery in that it is a minimally invasive surgery, and abundant research demonstrates comparable results from both modalities for postoperative complications, oncological outcomes, and functional outcomes. However, the cost of robot-assisted surgery limits surgeons to performing robotic surgeries in only selected cases. Improvements regarding cost-effectiveness and more convincing studies that support benefits of robotic surgery are needed to popularize robot-assisted colorectal surgery.

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The use of indocyanine green for lateral lymph node dissection in rectal cancer—preliminary data from an emerging procedure: a systematic review of the literature

Kehagias,

Lampropoulos,

Bellou

et al. 2024

Tech Coloproctol

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Introduction Lateral lymph node dissection (LLND) for rectal cancer is still not a widely established technique owing to the existing controversy between Eastern and Western countries and the lack of well-designed studies. The risk of complications and the paucity of long-term oncological results are significant drawbacks for further applying this technique. The use of indocyanine green (ICG) near-infrared (NIR) fluorescence for LLND appears as a promising technique for enhancing postoperative and oncological outcomes. This review aims to evaluate the emerging role of ICG during LLND and present the benefits of its application. Materials and methods Systematic electronic research was conducted in PubMed and Google Scholar using a combination of medical subject headings (MeSH). Studies presenting the use of ICG during LLND, especially in terms of harvested lymph nodes, were included and reviewed. Studies comparing LLND with ICG (LLND + ICG) or without ICG (LLND-alone) were further analyzed for the number of lymph nodes and postoperative outcomes. Results In total, 13 studies were found eligible and analyzed for different parameters. LLND + ICG is associated with significantly increased number of harvested lateral lymph nodes (p < 0.05), minor blood loss, decreased operative time, and probably decreased urinary retention postoperatively compared with LLND-alone. Conclusions The use of ICG fluorescence during LLND is a safe and feasible technique for balancing postoperative outcomes and the number of harvested lymph nodes. Well-designed studies with long-term results are required to elucidate the oncological benefits and establish this promising technique.

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Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection

Cited by 8 publications

References 6 publications

Simplified approach to the medial internal iliac region using a uretero‐hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot‐assisted radical prostatectomy for high‐risk prostate cancer

Simplified approach to the medial internal iliac region using a uretero‐hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot‐assisted radical prostatectomy for high‐risk prostate cancer

Robot-Assisted Colorectal Surgery

The use of indocyanine green for lateral lymph node dissection in rectal cancer—preliminary data from an emerging procedure: a systematic review of the literature

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