Extraperitoneal Laparoscopic Lymphadenectomy in Prostatic Cancer: Preliminary Report of a New Approach

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Abstract
An endoscopic extraperitoneal approach for pelvic lymphadenectomy was performed in nine patients with localized prostatic cancer prepared for radiotherapy. The technique consists of insufflation of the retropubic space with CO2 through a suprapubic puncture. The pelviscope is introduced into the inguinal canal through a second skin incision over the superficial inguinal ring and advanced in the inguinal canal until it crosses the deep ring into the extraperitoneal pelvic cavity. The vas deferens is taken as a guide in both the inguinal canal and the pelvic cavity. The lymph nodes in the floor of a triangle formed by the external iliac artery, vas deferens, and ureter are dissected, the triangle being cleared of lymph nodes and fatty tissue. The procedure is repeated on the contralateral side. No complications were encountered. Lymph nodes were identified in all the lymphadenectomy specimens from both sides and were positive for malignant cells in two patients. The extraperitoneal approach is direct, safer, and easier than the intraperitoneal one.