V12-09 THE ANATOMIC SCALENE TRIANGLE: A USEFUL LANDMARK FOR PELVIC LYMPHADENECTOMY DURING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-09 THE ANATOMIC SCALENE TRIANGLE: A USEFUL LANDMARK FOR PELVIC LYMPHADENECTOMY DURING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Jonathan Katz, Ali Merhe, Ali Mouzannar, and Mark Gonzalgo Jonathan KatzJonathan Katz More articles by this author , Ali MerheAli Merhe More articles by this author , Ali MouzannarAli Mouzannar More articles by this author , and Mark GonzalgoMark Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic lymphadenectomy (PLN) during Retzius-Sparing Robotic-Assisted Radical Prostatectomy (RS-RARP) may be challenging because the medial umbilical ligaments are not released, and the anterior structures are preserved. The incidence of symptomatic lymphoceles following PLN during RS-RARP has been reported to be higher than standard approaches for RARP. We describe the anatomic scalene triangle as a useful landmark to facilitate PLN during RS-RARP and compare the outcomes of PLN using this technique versus PLN for standard RARP. METHODS: This is a single center, institutional review board approved, retrospective case-control study of 200 consecutive patients undergoing RS-RARP or standard RARP. We compared perioperative factors such as age, BMI, grade group, tumor stage, lymph node yield, and incidence of symptomatic lymphoceles using t-test for continuous variables and Fisher’s exact test for categorical variables. A p-value of< 0.05 was considered statistically significant. In the RS-RARP, group the anatomic scalene triangle was used as a landmark for PLN. The scalene triangle is formed superiorly by the vas deferens, medially by the medial umbilical ligament, and laterally by the external iliac vein. The peritoneum overlying this triangle is incised superficially and an avascular plane in this space is developed. Retraction of the vas deferens and medial umbilical ligament facilitates exposure of the lymph node packet and the obturator nerve. Once the lymph node packet is isolated, surgical clips are applied and mobilization of the lymph nodes is performed cranially. Once the proximal extent of the dissection has been reached, the lymph node packet is divided and removed. RESULTS: There were no statistically significant differences between RS-RARP and standard RARP with respect to age, BMI, grade group, tumor stage, lymph node yield, or incidence of symptomatic lymphocele. Of note there were 4 symptomatic lymphoceles in the RS-RARP group and 1 symptomatic lymphocele in the standard RARP group. These were all treated with percutaneous drainage by interventional radiology. CONCLUSIONS: The anatomic scalene triangle is a useful landmark to facilitate safe and efficient PLN during RS-RARP and is associated with 4% incidence of symptomatic lymphoceles compared to prior, smaller series which demonstrated 8-16% incidence of symptomatic lymphoceles with PLN during RS-RARP. Though we observed more symptomatic lymphoceles in the RS-RARP group compared to standard RARP, this was not statistically significant. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1026-e1027 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Katz More articles by this author Ali Merhe More articles by this author Ali Mouzannar More articles by this author Mark Gonzalgo More articles by this author Expand All Advertisement Loading ...