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Lymph node dissection for intermediate and high risk prostate cancer

Implementation

During open surgery, a low midline incision is made from the symphysis to the umbilicus. The entire procedure is extraperitoneal.

  • During laparoscopy, the procedure is performed transperitoneally.
  • Remove fatty tissue and lymph nodes in one area limited to the urethral crossing over the common iliac artery, laterally to the external iliac artery and medially to the internal iliac artery. 
  • Identify the obturatorial nerve and obturatorial artery
  • Dissect the fatty tissue off the nerve and vein.
  • Ligate distal lymph vessels.
  • Check the hemostasis.

If staging is completed to assess curative radiation treatment, the nodes are put in formalin.

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