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Video

Session: Ongoing Videos

VM104 - Laparoscopic Left Lateral Pelvic Lymph Node Dissection In Female

ONGOING VIDEOS
Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • SUBHATHIRA MANOHKARAN, MS

    General surgeon and collorectal fellow
    Tata Memorial Cancer Centre
    Mumbai,, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Avanish P. Saklani, Tata memorial Hospital, Homi Bhabha National Institute, Mumbai

    Professor
    Division of colorectal Surgeon, Department of Surgical oncology
    Tata Memorial hospital , Mumbai
    Mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Yogesh K. Bansod, MS,MCh (surgical oncologist) (he/him/his)

    Consultant
    Bombay hospital and medical research centre marine lines Mumbai-400020
    TATA MEMORIAL HOSPITAL , HOMI BHABHA NATIONAL INSTITUTE PAREL MUMBAI.
    mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
SUBHATHIRA MANOHKARAN, MS: This individual has no financial relationships with ineligible companies.
Avanish P. Saklani, Tata memorial Hospital, Homi Bhabha National Institute, Mumbai: This individual has no financial relationships with ineligible companies.
Yogesh K. Bansod, MS,MCh (surgical oncologist): This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Lateral pelvic lymph node dissection (LPLND) is a technically demanding procedure, typically performed in patients with residual lymph nodes after neoadjuvant radiotherapy. A thorough understanding of the anatomy of this narrow and deep space is essential for ensuring safe and effective surgery.
In the presented video, we performed LPLND on a 34-year-old female with large left lateral pelvic lymph nodes following total neoadjuvant treatment. Her nodes were located in the left obturator group, near the lateral pelvic wall and external iliac vessels. To achieve complete clearance, we undertook an additional step of mobilizing and skeletonizing the external iliac artery and vein.

Methods/Interventions: Informed consent was obtained from the patient for publication purposes, and all efforts have been made to ensure that the patient’s identity remains undisclosed.
We illustrate the key steps involved in performing LPLND, including an additional technique for addressing nodes located near the external iliac vessels. The video also highlights the precise anatomical structures within the dissected space.

1.Patient Preparation- Mechanical bowel preparation with oral antibiotics and preoperative intravenous antibiotics

2.Patient Position- Lloyd Davies position with the operating table tilted to the right side (surgeon side).

3.Critical Steps- Mobilizing the ureter and gonadal vessels medially, creating both medial and lateral paravesical spaces, mobilizing and dissecting along the external iliac artery and vein; and followed by lymph node dissection.

4.Technical Pearls/Tips-
a. Opening along the ureterohypogastric fascia.
b. Mobilising the external iliac vessels while preserving all nerves

5. Potential Areas for Injury/Complication-

a. Ureteric injuries during dissection along the hypogastric fascia.

b. Risk of vascular and nerves injury

c. Risk of bladder devascularization (superior vesical artery)

Results/Outcomes: Not applicable

Conclusion/Discussion: Not applicable