As the role of robotic surgery in urologic oncology has evolved, pelvic lymphadenectomy remains an important part of the staging of patients with prostate, bladder, and penile cancer. Complications associated with robotic pelvic lymphadenectomy are related to the proximity of the lymph nodes to major vascular, nerves, and lymphatic channels. The most common complication after pelvic lymphadnectomy is lymphocele formation and occurs due to incomplete control of lymphatic channels. The extent of lymphatic dissection correlates with lymphocele formation. Most lymphoceles are subclinical and do not require treatment; however, some may result in leg swelling, pelvic pain, or infection and require drainage. Vascular injury is rare during pelvic lymphadenectomy but can be repaired by experienced laparoscopic and robotic surgeons. The principles of gaining proximal and distal control of the injured vessel and precise repair are keys to successful outcomes. The obturator nerve is at risk for injury from cautery, clips, and traction during pelvic lymphadenectomy. Complete transection can be repaired by precise approximation of the epineural tissues using fine suture. Injury to the ureter can be avoided during pelvic lymphadenectomy by understanding that the ureter travels deep to the median umbilical ligament as it travels distally to the bladder.
KeywordsLymphadenectomy Lymph node dissection Robotic surgery Lymphocele Vascular complications Obturator nerve
- 4.Grande P, Di Pierro GB, Mordasini L, Ferrari L, Wurnschimmel C, Danuser H, Mattei A. Prospective randomized trial comparing titanium clips to bipolar coagulation in sealing lymphatic vessels during pelvic lymph node dissection at the time of robot-assisted radical prostatectomy. Eur Urol. 2017;71:155–8.CrossRefPubMedGoogle Scholar
- 12.Safi K, Teber D, Moazen M, Anghel G, Maldonado R, Rassweiler J. Laparoscopic repair of external iliac artery transection during laparoscopic radical prostatectomy. J Endocrinol. 2006;20:237–9.Google Scholar
- 16.Taneja S. Chapter 40, complications of lymphadenectomy. In: Complications of urologic surgery-prevention and management. 4th ed. Philadelphia: Saunders Elsevier; 2010. p. 464–5.Google Scholar
- 21.Williams SK, Rabbani F. Complications of lymphadenectomy in urologic surgery. Urol Clin North Am. 2011;38(4):507–18–vii.Google Scholar