Laparoscopic staging pelvic lymphadenectomy: extraperitoneal approach.

Comparative studies have proven the feasibility as well as reduced morbidity of endoscopic pelvic lymph node dissection when compared to open pelvic lymphadenectomy. Transperitoneal laparoscopic pelvic lymphadenectomy, however, has been associated with complications related to transperitoneal access and intraperitoneal dissection. We, therefore, developed the extraperitoneal laparoscopic staging pelvis lymph node dissection which combines the anatomic principles of open pelvic lymphadenectomy with the minimally invasive endoscopic technique. Exploration of the area of our endoscopic lymphadenectomy during radical retropubic prostatectomy proved the feasibility of our dissection. In patients selected for laparoscopic lymphadenectomy, we now prefer the extraperitoneal approach.