Laparoscopic Extended Pelvic Lymph Node Dissection During Radical Cystectomy: Technique and Outcomes

Abstract Introduction: Laparoscopic radical cystectomy (LRC) is both safe and efficacious. Extending the laparoscopic limit by doing extended pelvic lymph node dissection (PLND) and then doing external diversion by a small Pfannenstiel incision can further decrease the morbidity of the procedure while maintaining oncologic efficacy. We intend to perform and evaluate laparoscopic extended PLND (EPLND) in patients undergoing LRC with ileal diversion by a four-port split-and-roll technique. Materials and Methods: The essential steps of the procedure include patient in steep 45° Trendelenburg position with the surgeon and camera assistant on left position, 12 mm supra umbilical port for camera, 12 mm dissection port at the previously marked ileal conduit site, 5 mm retraction, and assistant port in left and right quadrant. Root of bowel mesentery is reflected cranially to expose aortic bifurcation. The packet is longitudinally divided anterior to the artery (iliac and aorta) using the split-and-roll technique...