Prostate Cancer -Laparoscopic Extended Pelvic Nodes Excision

The following video shows a dissection of pelvic lymph node due to prostate cancer. The goal of laparoscopic pelvic lymph node dissection is to exclude high-risk patients from noncurative therapy and to stage high-risk patients at the time of prostatectomy performed robotically or laparoscopically. Pelvic lymphadenectomy remains the criterion standard for detecting metastatic spread to the pelvic lymph nodes. The indications for staging pelvic lymphadenectomy before prostatectomy include the following: prebiopsy serum prostate-specific antigen (PSA) level greater than 20 ng/mL; Gleason sum equal to 8 or greater, five or more positive systematic sextant biopsies or total linear involvement of 28% or more; palpably advanced local disease, clinical stages T3 and T4, positive seminal vesicle biopsy, enlargement of pelvic lymph nodes as seen by pelvic imaging.