Laparoscopic Right Lateral Pelvic Lymph Node Dissection (LPLND) with Pelvic Autonomic Nerve Preservation

Abstract

During lateral pelvic lymph node dissection (LPLND), it is important to visualize the lateral pelvic space to be removed and to identify the proper dissection boundaries. Dissection proceeds along (1) the pelvic wall side of the plexus (internal LPLND margin), (2) the external iliac vessels (superior margin), (3) the pelvic sidewall (lateral margin), (4) the internal iliac vessels (dorsal margin), and (5) the bladder (ventral margin). In addition, beyond the bifurcation of the inferior vesical artery, the most caudal part of the lymph node tissues should be dissected, which is surrounded by the lateral sidewall, the pelvic nerve plexus, and the levator ani muscles. It is recommended that the lymph node tissues caudal to the root of the inferior vesical artery and around Alcock’s canal be completely removed. Arterioles and venules penetrating the pelvic sidewall should be cut meticulously with an appropriate vessel-sealing system to prevent unnecessary bleeding. In some cases of metastatic lateral lymph nodes, an en bloc resection along with the surrounding plexus and/or internal iliac vessels is necessary to ensure a satisfactory clearance to the circumferential resection margin.