V26 - Laparoscopic approach for Complex lateral pelvic lymph node dissection in rectal cancer.

Purpose/Background: Lateral pelvic lymph node dissection (LPLND) remains technically challenging, especially in previously irradiated pelvis. This study aims to describe a standardized laparoscopic approach for extended LPLND in rectal cancer, emphasizing anatomical planes, safety, and nerve preservation.

Methods/Interventions: A stepwise dissection technique was demonstrated in a patient positioned in modified lithotomy after adequate bowel and thrombotic prophylaxis. The dissection proceeded through defined planes-ureterohypogastric fascia (Plane A), external iliac vessels (Plane B), internal iliac vessels (Plane C), obturator fossa (Plane D), and lumbosacral trunk-ensuring systematic clearance while preserving vital structures. Strategies for managing fibrosis and preventing vascular or nerve injury were detailed.

Results/Outcomes: The laparoscopic approach enabled complete clearance of fibro-fatty nodal tissue from the lateral pelvic compartment with preservation of pelvic nerves and hemostasis. The video highlights critical anatomic landmarks and technical nuances facilitating safe and reproducible dissection even in post-radiation settings.

Conclusion/Discussion: Laparoscopic extended LPLND is feasible and safe in expert hands. Meticulous adherence to anatomical planes and early vascular control are key to minimizing complications. The described approach provides a valuable roadmap and teaching aid for advanced pelvic oncologic surgery.