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Common Questions: The Procedure

Can pelvic lymph nodes be removed with laparoscopic radical prostatectomy?

Yes. Pelvic lymph nodes, to which prostate cancer may spread, can be removed during a laparoscopic radical prostatectomy.

Lymph node removal is of little use in most cases of prostate cancer detected in the modern era; with wide use of prostate PSA tests, most prostate cancers are detected at very early stages.

Pelvic lymph node removal carries risks less likely with just laparoscopic radical prostatectomy: injury of the very large iliac vein, laceration of the obturator nerve, and formation of lymph collections in the pelvis. The decision to remove lymph nodes depends on an individual risk-benefit analysis that today almost always favors not removing them. 

In the photo, one can see the pelvic anatomy after the external iliac pelvic lymph nodes have been removed. A window has been opened in the peritoneum. Exposed through the window is the arc of the pubic bone. Seen below that is the obdurator nerve, a whitish thin line. Running vertically on the right are the blue-colored external iliac vein and the pink external iliac artery. The lymph nodes were originally positioned over the bone, left of the vein, above the nerve.

after removal of the external iliac pelvic lymph nodes