Recently, robotic approaches to prostatectomy and cystectomy have been reported. However, for both prostate cancer and bladder cancer, the associated lymphadenectomy has remained an important diagnostic and even therapeutic part of the procedure. We describe our approach and outcomes with a robotic-assisted laparoscopic pelvic lymphadenectomy for bladder cancer.

120 patients underwent a robotic PLND as part of robotic prostatectomy (n=35) and robotic cystectomy (n=85) procedures. Of all patients undergoing robotic prostatectomy procedures (n=350), 35 men(10%) underwent PLND and in all cases this was a limited PLND. Of the cystectomy patients, all 85 patients (100%) underwent either a standard dissection (52%) or extended/common iliac dissection (48%). We describe the approach and results of a standard (external iliac) and extended (common iliac +/- para-aortic) pelvic lymph node dissection for bladder cancer via a robotic approach at the time of surgery.

35 patients underwent limited PLND with a mean (range) lymph nodes removed of 9 (3-28). 44 patients have undergone standard dissection with a mean (range) lymph nodes removed of 17 (8-37). 41 patients have undergone extended dissection with a mean (range) lymph nodes removed of 22 (9-40). There have been no complications that were attributable to the lymph node dissection. Technical aspects and tricks of the robotic PLND -- including obturator, iliac, and para-aortic dissection -- will also be discussed.

Robotic pelvic lymphadenectomy for prostate and bladder cancer is a feasible approach with adequate access, exposure, and excision of lymph nodes in both a standard and extended fashion.