When prostate cancer spreads, it goes to the pelvic lymph nodes. Determining whether cancer has reached these nodes is extremely important because the treatment options are different for patients whose nodes are involved than for those with cancer confined within the prostate gland. Blood levels of prostate-specific antigen and results of prostate biopsy and digital rectal exam offer useful information, but when there is a high index of suspicion that the disease has spread, biopsy of the lymph nodes is warranted.
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 postoperatively. This complication may be minimized by the use of laparoscopic magnification.
The operation lasts about one hour, and the hospital stay is usually 24 hours. The amount of pain medication required after the procedure and the time before returning to work are significantly less than with the open technique. The amount of tissue sampled using the laparoscopic technique is similar to that obtained using the open technique.