Robotic Lateral Pelvic Lymph Node Dissection for Advanced Low Rectal Cancer

Lateral pelvic lymph node dissection (LPND) represents a treatment option for patients with locally advanced low rectal cancer and suspected lateral pelvic nodes. Many of these patients could develop locoregional recurrence when treated with total mesorectal excision alone. However, LPND is a technically demanding procedure burdened by a non-negligible risk of intraoperative bleeding and postoperative genitourinary dysfunction. The robotic platform may represent the best option for minimally invasive LPND, providing fine movements, good traction, and stable camera. Indeed, robotic LPND is associated with decreased intraoperative blood loss and lower rates of urinary retention compared to the laparoscopic approach. We present here our standardized technique based on the dissection of three potential fascial planes within the lateral pelvic sidewall: plane A, the innermost, containing the ureter and the hypogastric and pelvic nerves; plane B, the outmost, defined by the external iliac vessels and psoas and obturator internus muscle; plane C, lateral to the internal iliac vessels and their branches. Standard LPND includes the obturator and internal iliac node group.