Robotic-Assisted Prostatectomy with Pelvic Lymph Node Dissection

In prostate cancer, removing the pelvic lymph nodes is the most reliable way to find out whether the cancer has spread, because scans often miss small nodal disease. When the risk of spread is high enough, the surgeon adds a pelvic lymph node dissection (PLND) to the radical prostatectomy, and "possible" in the booking reflects that the node dissection is done when it is indicated. Nodes may be sent for frozen section, and positive nodes can change how much is removed or what treatment follows. Men with low-risk cancer are often spared the dissection. The extent of the dissection varies. A limited template takes the nodes in the obturator fossa, often with those over the external iliac vessels. An extended template adds the nodes over the internal iliac (hypogastric) and common iliac vessels and can yield about 13 to 24 nodes. In the robotic operation on this page the node dissection is done first on each sidewall, with clips on the lymph channels, and the prostatectomy follows a posterior-first laparoscopic sequence: the vasa and seminal vesicles are freed from behind before the bladder is dropped forward. The page "Robotic-Assisted Radical Prostatectomy" covers the operation without the node dissection. The main extra risk of the node dissection is a lymphocele, a collection of lymph fluid in the pelvis, which happens in roughly 3 percent of robotic cases and occasionally needs drainage. Injury to the obturator nerve or iliac vessels is rare. After laparoscopic surgery, the drain and catheter come out on about the third day, and a blood thinner is prescribed for two weeks.