A new technique for robotic lateral pelvic lymph node dissection for advanced low rectal cancer with emphasis on en bloc resection and inferior vesical vessel preservation.

Abstract

Lateral pelvic lymph node (LPLN) dissection is becoming increasingly important in the treatment of advanced low rectal cancer patients. However, the surgery has several disadvantages, including its technical complexity and high risk of urinary dysfunction. Herein, we report a new technique for robotic lateral pelvic lymph node dissection for advanced low rectal cancer with emphasis on en bloc resection and inferior vesical vessel preservation. Robotic LPLN dissection was performed in 12 consecutive patients between April 2020 and December 2021. Six surgical ports were placed in the abdomen under general anesthesia. Fascia-oriented LPLN dissection of the internal iliac region and obturator region was performed using the ureterohypogastric nerve fascia, vesicohypogastric fascia, and internal obturator muscles as anatomical landmarks. Lymph nodes were resected en bloc via the caudal side of the inferior vesical vessels. The inferior vesical vessels were spared to prevent urinary dysfunction. The median patient age was 62years (range, 43-82years), and eight patients were male. The median operative time was 498min (range, 424-661min), the median bleeding volume was 56ml (range, 13-467ml), and the median number of harvested LPLN was 16 (range, 1-70). The conversion rate to open surgery was 0%. Clavien-Dindo Grade ≥ II urinary dysfunction rated was not observed. A new technique for robotic LPLN dissection for advanced low rectal cancer with emphasis on en bloc resection and inferior vesical vessel preservation can be safely performed, making it a promising surgical procedure.