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Pelvic paraaortal lymph node dissection/sampling

Implementation

  • Open the space between the ureter and the pelvic wall.
  • Hold the ureter on the medial side and dissect down on the lateral side.
  • Open the paravesical space.
  • Split the tissue over the external iliac artery.
  • Use forceps and start on the medial side. Hold the nodes while the assisting surgeon carefully releases them.
  • Spare femoral genital nerve to avoid paralysis.
  • Localize the obturator nerve in the obturator fossa.
  • Locate the lymph nodes above this and remove them.
  • Remove the lymph nodes by the common iliac artery.
  • Use clamps to secure lymphatic vessels if needed.
  • Extirpate the same amount of lymph nodes from both sides.
  • Put the lymph nodes in formalin for evaluation by a pathologist.

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