A Laparoscopic Pelvic Lymph Node Dissection (L.P.L.N.D) is the removal of the pelvic lymph nodes, using key-hole surgery, through five small incisions made in the abdomen.

The lymphatic system is one of the body's natural defenses. It is made up of lymph vessels that contain lymphatic fluid, a nearly clear fluid that carries waste from the cells of the body to the lymph nodes, which act like filters, filtering unwanted substances. The pelvic lymph nodes are the first 'port-of-call' for the cancer cells as they exit from the prostate gland through the lymphatic system. The L.P.L.N.D removes the lymph nodes in the pelvis by using laparoscopic equipment. Long thin instruments are passed through five small incisions made on the abdomen, these are known as 'ports', (Fig. 1). There is one 'port' just below the umbilicus (your belly button), and two on either side of the lower abdomen, each is about 1cm in length. Through these 'ports' the laparoscopic equipment is passed. The abdomen is first filled with carbon dioxide air, which separates the tissues to allow for vision during the surgery. A camera is passed through the laparoscopic equipment and its images are watched on a television screen, giving the Urologist a full picture inside the abdomen. The other ports are used to pass cutting and cauterising instruments so the lymph nodes can be removed and any bleeding points can be sealed. When the operation is finished the carbon dioxide air is removed from the abdomen and the cuts are stitched closed with dissolving stitches. The areas are then covered with small plasters.

The lymph nodes are sent to the laboratory for analysis and reporting so further treatment decisions can then be made.

WHY IS A L.P.L.N.D. NEEDED?

This operation is for men with prostate cancer and gives further information about any spread of the disease. By removing the pelvic lymph nodes your specialist is able to determine whether or not there has been any spread of the cancer out of the prostate gland. This information is used to help determine the appropriate treatment for you. If there is no cancer in the lymph glands either radiation treatment or surgical removal of the prostate gland may be undertaken. However, if the cancer has spread to the lymph glands the best treatment option may be hormonal therapy to stabilise the disease and help delay further spread.