Indications - Prostate cancer first spreads to the pelvic lymph nodes. Determining if the cancer has reached the pelvic lymph nodes is extremely important because the treatment options for those patients are different than those with cancer confined within the prostate gland. The individuals prostate blood test level (prostate specific antigen or PSA), appearance of the prostate biopsy as evaluated under a microscope, and their digital rectal exam can help predict if the cancer has spread to the lymph nodes but is not always accurate. In those patients with a high index of suspicion of lymph node seeding a lymph node sampling is required.
Procedure - Three ports are placed to perform this procedure. Pelvic lymph nodes are sampled from both the right and left side. The camera provides magnification to help prevent injury to major arteries, veins and nerves that surround the pelvic lymph nodes. In addition lymphatic injury when unrecognized may cause significant fluid accumulation post-operatively. This complication may be minimized by the use of laparoscopic magnification.
Results - The operation takes about one hour to perform with a hospital stay of 24 hours. The amount of narcotics required after the procedure and time to return to work is significantly less when compared to the open technique. The amount of tissue sampled using the laparoscopic technique is similar to that obtained using the open technique.
