Laparoscopic Pelvic Lymphnode Dissection
Preparation & Setup
- Patient is placed in modified Lloyd Davis position with gluteal fold at the end of the table to allow access to perineum.
- Abdominal skin preparation from mid chest to mid thighs.
- Under buttocks, legs, sides, top and bottom.
- Vaginal preparation & Foley’s catheter insertion.
- Bipolar grasper energy set to 60 units
- 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