Volume 57, Issue 1, Pages 71-78 (January 2010) Optimizing the Approach for Lymph Node Dissection during Laparoscopic Radical Cystectomy  Ahmed Ghazi, Reinhold Zimmermann, Amjad Al-Bodour, Alexander Shefler, Gunter Janetschek  European Urology  Volume 57, Issue 1, Pages 71-78 (January 2010) DOI: 10.1016/j.eururo.2009.06.024 Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 1 The field of dissection: region 1, paracaval; region 2, interaortocaval; region 3, para-aortic; region 4, common iliac; region 5, intercommon iliac (presacral); region 6, external iliac; region 7, obturator; region 8, internal iliac; region 9, internal iliac branches (medial to the internal iliac). European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 2 Trocar arrangement: (A) The classical five-trocar arrangement for radical pelvic surgery; (B) our modified trocar arrangement. The 11-mm optic trocar is repositioned supraumbilically and at the midline; the right lateral 5-mm trocar is also repositioned supraumbilically and medially. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 3 Mobilization of the sigmoid colon: (A) schematic diagram; (B) endoscopic view. U=ureter; C=colon. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 4 Retraction of the mobilized colon using an umbilical tape: (A) passing the tape across the undersurface of the mobilized colon; (B) delivery of both ends of the tape out through the trocar; (C) using a trocar obturator to deliver the tape outside the trocar lumen; (D) final position of the tape beside the trocar. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 5 Left retraction of the mobilized colon exposes the complete right side as well as the left side down to the left iliac bifurcation, which is dissected from right to left: (A) schematic diagram; (B) endoscopic view. The dissected inferior mesenteric artery lies at the cranial border of the template. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 6 Endoscopic view after completing the extended lymph node dissection. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 7 Schematic diagram of the range of vision at the cranial border offered by a 0° telescope at or below the umbilicus. Notice the unusual direction of the optic. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 8 Schematic diagram of the range of vision at the cranial border offered by a 30° telescope above the umbilicus with the optic maintained in a normal direction. European Urology 2010 57, 71-78DOI: (10.1016/j.eururo.2009.06.024) Copyright © 2009 European Association of Urology Terms and Conditions