V2 - Application of ' page-turning ' Internal Iliac Perivascular Lymph Node Dissection Technique in Laparoscopic Lateral Lymph Node

Purpose/Background: To explore the application value of the "page-turning" technique for lymph node dissection around the internal iliac vessels in laparoscopic lateral lymph node dissection (LLND)

Methods/Interventions: A high proportion of rectal cancer patients experience lateral lymph node metastasis, with NO.263 D dissection being challenging. This video highlights a 'page-turning' method for dissecting NO.263 P and D lymph nodes along the internal iliac vascular sheath, simplifying the process and showing the treatment of vessel invasion. The surgery is divided into five parts:
The first step is to separate the ureterohypogastric nerve fascia, open the posterior peritoneum along the outer side, and free the medial edge of the internal iliac artery and the ureter.
In the second step, the vesicohypogastric fascia was dissociated, and the space between it and the obturator lymphatic adipose tissue was separated along the umbilical artery. Combined with the first step, the medial boundary of lateral dissection was established.
The third step is to separate the space between the pelvic fascia, external iliac vessels, and obturator lymphatic adipose tissue, expose the iliopsoas muscle and the obturator internal muscle as the lateral boundary of the cleaning, clean the obturator lymphatic adipose tissue on the lateral side of the abdominal fascia of the bladder, and pay attention to protecting the obturator nerve.
In the fourth step, the NO.263 P and NO.263 D lymph nodes were dissected along the internal iliac vessels. Guided by the internal iliac artery, the proximal end was dissected to the sacral fascia, and the anterior trunk of the internal iliac artery was dissociated along the distal end to expose the internal pudendal artery. The umbilical artery, the vessels around the bladder wall, and the proximal end of the obturator vessel were ligated in turn.
The fifth step, close to the bladder wall and ureter, cut off the distal end of the bladder vessels, completely freeing NO.263 P and NO.263 D lymph nodes.
In addition, an enlarged lymph node was found to invade the branch of the internal iliac vein during the operation. The surgeon ligated the distal and proximal ends of the invaded vessels to thoroughly clean the enlarged lymph nodes.

Results/Outcomes: The Patient recovered well, discharged on Day 5 without complications.

Conclusion/Discussion: The "page-turning" technique for lymph node dissection around the internal iliac vessels simplifies and standardizes the dissection of the No. 263 lymph node group by redefining the anatomical surgical plane, offering a new technical option for lymph node dissection in this region.