Akademik Veri Yönetim Sistemi
WCE 2022 , California, Amerika Birleşik Devletleri, 1 - 04 Ekim 2022, ss.306
Introduction & Objective: This video presents a retrograde
paraaortocaval lymphadenectomy procedure performed after
super extended lymphadenectomy and robotic radical prostatectomy in a patient with very high risk prostate cancer.
Methods: The patient was a 67 years old gentleman with a PSA
of 28 ng/ml. Prostate biopsy revealed Gleason 9 (4 + 5) prostate
cancer in 12 of 12 cores. Ga68 PSMA PET showed multiple
lymph only metastasis of paraaortocaval region up to the renal
hilum. The patient received 6 cycles of chemohormonotherapy
prior to the surgical treatment. After completion of radical
prostatectomy and super extended lymphadenectomy an additional suprapubic camera port was inserted in the midline for
retrograde access. Robotic crane was turned 180 degrees facing
cranial. Lymphadenectomy template was extended up to the level of renal pedicle. First posterior peritoneum was opened from
caecum to Treitz ligament , and right ureter was identified.
Posterior peritoneum was lifted up on both sides via externally
placed stay sutures. Upper limit of the lymphadenectomy template was identified. Caval and paracaval lymph nodes were
excised with blunt and sharp dissection and using Weck clips.
Great attention was paid to occlude large lymphatic vessels with
Weck clips. Next step was identification of left ureter through
mesosigmoideum. Left common iliac lymph nodes were removed below the mesenteric artery. Interaortocaval lymph nodes
were excised with blunt and sharp dissection. Large lymphatic
vessels were occluded with Weck clips. During interaortocaval
lymph node dissection extra care must be paid no-t to damage
lumbar branches. Right renal artery was identified and preserved
precisely. Then aortic and paraaortic lymph node dissection was
started. During paraaortic lymph node dissection inferior mesenteric artery was identified and preserved carefully. Again,
Weck clips were used to occlude large lymphatic vessels. After
completion of paraaortocaval and interaortocaval lymph node
dissection, surgical field was controlled carefully for potential
bleeding.
Results: Estimated blood loss was 250 ml. and the operation time was 300 minutes. The drain was removed on postoperative second day and the patient was discharged on
postoperative fifth day. On final histopathology, there was T3B
N1 prostate cancer. Six out of 68 lymph nodes were positive for
metastasis. Three of positive lymphs were in the paraaortocaval
region.
Conclusions: At postoperative 12 month follow-up, the patient
is still on antiandrogen treatment and has a nadir PSA level.