PTU - Polskie Towarzystwo Urologiczne
list of articles:

THE LAPAROSCOPIC OBTURATOR LYMPH NODE DISSECTION IN PATIENTS WITH PROSTATIC CARCINOMA
Article published in Urologia Polska 1999/52/2.

authors

Grzegorz Kata, Artur A. Antoniewicz, Andrzej Borówka
Oddział Urologii Centralnego Szpitala Kolejowego w Warszawie
Ordynator Oddziału: prof. dr hab. n. med. A. Borówka

keywords

prostate carcinoma lymphadenectomy laparoscopy

summary

20 patients aged 51-75 underwent laparoscopic obturator lymph node
dissection between 1996-1998. All of them with histologically proved prostate
carcinoma (clinical stage T ? 3 No M()) were ±ualified for staging before
radiotherapy. The method of the bilateral access to fossa obturatoria called
"butterfly suture" was performed in 15 patients. The idea of the techni±ue is to
make a suture looking like butterfly at laparoscopy. A PDS suture on rectilinear
needle is introduced into the perineal cavity percutaneously. Afterwards both
of the medial edges of incised peritoneumare protracted. The suture after
crossing is knotted extracorporeally - fraction of the ends of the suture gives
wide opening of both obturator fossas. Lymphatic tissue was removed
completely. The nodes were metastatic in three patients. There were no
intraoperative complications. We observed early postoperative complications
in three patients. The lymphocele occurred in one patient two weeks following
radiotherapy.
Considering our experience laparoscopy is minimally invasive and safe
method of removal of obturator lymph nodes at patient with prostatic carcinoma
for the staging before radiotherapy or perineal prostatectomy. Laparoscopic
lymphadenectomy is suitable alternative to other more invasive techni±ues.
The "butterfly suture" improves performing procedure.

references

  1. [1] Antoniewicz, A. A., Kata, S. G., Borówka, A.: Improvement of the appro-
  2. ach to fossa obturatoria at the laparoscopic lymphadenectomy. MITAT 1998, 7,
  3. suppl. 1, 52.
  4. [2] Boeckmann, W., Effert, R, Wolff, T. M., Jakse, G.: Laparoscopicpehic lym-
  5. phadenectomy, Acta Urol. Belg. 1994, 62, 45-50.
  6. [3] Brant, L. A., Brant, W. O., Brown, M. H., Seid, D. L., Allen, R. E.: A
  7. new minnimally invasive open pehic lymphadenectomy surgical techni±ue for the
  8. staging of prostate cancer. Urology 1996, 47,416-421.
  9. [4] Catalona, W. ]., Stein, A. J.: Staging errors in Clinically localized prostate can-
  10. cer. J. Urol. 1982,127, 452-456.
  11. [5] Fishman, J. R., Moran, M. E., Carey, R. W.: Obturator neuropathy after
  12. laparoscopic pehic lymphadenectomy. Urology 1993, 42,198.
  13. [6] Gervasi, L. A., Mata, J., Easley, J. D., Wilbanks, J. K., Seale-Hawkins,
  14. C, Carlton, C. E.: Prognostic significance of lymph nodal metastases in prostate
  15. cancer. J. Urol. 1989,142, 332-336.
  16. [7] Guazonni, G., Montorsi, F., Bergamaschi, F., Bellinzoni, R, Centeme-
  17. ro, A., Consonni, R, Rigati, R: Open surgical revision of laparoscopic pelvic
  18. lymphadenectomy for staging of prostate cancer: The impact of laparoscopic lear-
  19. ning cuwe. J. Urol. 1994,151, 930-933.
  20. [8] Herrell, S. D., Trachtenberg, }., Theodorescu, D.: Staging pelvic lympha-
  21. denectomy for localized carcinoma of the prostate: A Comparison of three surgical
  22. techni±ues. J. Urol. 1997,157 (4), 1337-9.
  23. [9] Lieskovsky, G., Skinner, D. G., Weisenburger, T.: Pełnie lymphadenecto-
  24. my in the management of carcinoma of the prostate. J. Urol. 1980,124, 635-638.
  25. [10] Mazeman, E., Wurtz, A., Gilliot, R, Biserte, J.: Extraperitonealpehioscopy
  26. in lymph node staging of bladder and prostatic cancer. J. Urol. 1996,147, 366-340.
  27. [11] Mukamel, E., Hannah, J., Barbarie, Z., DeKernion, J. B.: The value of
  28. Computerized tomography scan and magnetic resonance imaging in staging prosta-
  29. tic carcinoma: Comparison with the clinical and histological staging. J. Urol. 1986,
  30. 136,1231-1233.
  31. [12] Narayan, R, Fournier, G., Gajendran, V., Leidich, R., Lo, R., Wolf, J.
  32. S.: Utility ofpreoperatwe serum prostate - specific antigen concentration and biop-
  33. sy Gleason score in predieting risk of pelvic lymph node metastases in prostate
  34. cancer. Urology 1994, 44, 519-524.
  35. [13] Querleu, D.: Laparoscopic pelvic lymphadenectomy. The Thirteenth Internatio-
  36. nal Workshop on reconstructwe pelvic surgery in Gynaecology. Leuven, Belgium:
  37. August 31th-September 2nd, 1989.
  38. [14] Schuessler, W. W., Vancaillie, T. G., Reich, H., Griffith, D. R: Transperi-
  39. toneal endosurgical lymphadenectomy in patients with localized prostate cancer. J.
  40. Urol. 1991,145, 988-991.
  41. [15] Shafik, A.: Extraperitoneal laparoscopic lymphadenectomy in prostate cancer: pre-
  42. liminary report of a new approach. J. Endourol. 1992, 6,113-116.
  43. [16] Walther, U.: Die Wertigkeit von Computertomographie (CT), Magnetresonanzto-
  44. mographie (MRT), transrectaler Sonographie (TRU¦) und prostata-spezifischem An-
  45. tigen (PSA) bei die praoperatwen Diagnostik des lokalisierten Prostatakarzinoms.
  46. Dissertation Humboldt-Universitat, Berlin 1994.