Laparoscopic Pelvic Lymphnode Dissection

Author

Preparation & Setup

Positioning

  • Patient is placed in modified Lloyd Davis position with gluteal fold at the end of the table to allow access to perineum.

Draping

  • Abdominal skin preparation from mid chest to mid thighs.
  • Under buttocks, legs, sides, top and bottom.
  • Vaginal preparation & Foley’s catheter insertion.

Instruments

  • Bipolar grasper energy set to 60 units
  • Harmonic
  • Schneider grasping forceps
  • Zero degree 10mm laparoscope
  • 3x 5mm accessory balloon ports
  • Drain (if required) – Jackson-Pratt on free drainage
Retroperitoneal access and development of medial dissection border
 
  • Develop retroperitoneal space by division of round ligament laterally, divide peritoneum along the medial border of psoas muscle with identification of genitofemoral nerve until level of paracolic gutter
  • Identify obliterated umbilical artery – dissect along lateral border to origin from anterior branch of iliac vessels bifurcation
 
Caudal and lateral border dissection
  
 
  • Identify deep circumflex vessels
  • Dissection orientation from lateral to medial and caudal to cranial
  • Initiate from lateral and caudal borders and dissect from external iliac vessels
Inferior border and completion of en-bloc dissection
 
 
 
 
  • Once below external iliac vein, follow pubic bone to identify obturator nerve as it crosses the obturator foramen, acknowledging corona mortis vessel
  • Collect lymph nodes within anatomical boundaries
  • Ensure haemostasis
Acknowledgment

The video was edited by Dr Sarah Smyth