Tips and tricks for robotic lateral pelvic node dissection
Article information
Abstract
Lateral pelvic node dissection can be challenging. In addition to detailed anatomical knowledge of the pelvic side wall, surgeons also need to be proficient in performing fine dissection within the confines of this limited operative field. While the incorporation of robotics can facilitate the safe completion of this technically demanding procedure, this is nonetheless dependent on the way the robotic system is used. This video aims to demonstrate several tips and tricks for performing robotic lateral pelvic node dissection.
Lateral pelvic node dissection (LPND) can be challenging. Part of the problem arises from the fear that besets the surgeon when embarking on this procedure. This can be attributed to the fact that the pelvic side wall (PSW) is unfamiliar territory for most colorectal surgeons, compounded by the complex vascular anatomy within—namely, the multiple branches of the internal iliac vessels. Many surgeons are apprehensive about the disastrous consequences that can result from potential neurovascular injury during LPND. In addition, the procedure involves technically demanding dissection. First, the tissue planes can be ill-defined and edematous due to lymphatic congestion and radiotherapy. The resultant surgical plume also makes it challenging to maintain clear visualization of the operative field. In addition, the limited space for retraction and dissection results in suboptimal ergonomics, placing a greater demand on an experienced bedside assistant.
Apart from an in-depth knowledge of the 3-dimensional anatomy of the PSW, including the boundaries and landmarks for dissection, the use of robotics helps to facilitate the safe completion of this procedure. This video (Supplementary Video 1) aims to provide 4 tips and tricks that surgeons can incorporate into their practice of robotic LPND: (1) the protection of essential structures; (2) safe dissection; (3) dealing with bleeding; and (4) improving visualization.
Notes
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Author contributions
Conceptualization: all authors; Writing–original draft: JCYN; Writing–review & editing: NZT. All authors read and approved the final manuscript.
Additional information
This video was presented at the 2023 Asian Robotic Camp for Colorectal Surgeons (ARCCS) on October 19–21, 2023, in Seoul, Korea.
Supplementary materials
Supplementary Video 1. Tips and tricks for robotic lateral pelvic node dissection.
Supplementary materials are available from https://doi.org/10.3393/ac.2023.00766.0109.