San Antonio, Texas USA (UroToday.com) In this session, Dr. Power discussed novel insights into retroperitoneal anatomy in nerve-sparing retroperitoneal lymph node dissection based on an elegant cadaveric study. Twenty-one human embalmed cadavers and eight fresh cadavers were dissected in order to better understand the relative anatomy of the infrarenal vasculature defined as the lumbar vessels, right gonadal vein, and inferior mesenteric artery.
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The major findings indicate that the position of the right gonadal vein is helpful to locate the right superior lumbar vein and the inferior mesenteric artery is useful for helping to identify the second pair of infrarenal lumbar arteries. He noted that bleeding from the inferior vena cava (IVC) when the surgeon thinks he has control of the all the lumbar vessels may be due to a failure to identify and control the superior lumbar vein, which often arises directly posteriorly on the IVC. Lastly, the lumbar splanchnic nerves supplying the aortic plexus are typically located anteriomedical to the respective lumbar veins. For these discussions, the pictures in his recently published manuscript (see below for reference) are worth the time to look up the article and describe more than words would ever be able to convey. This study adds a remarkably complete description of retroperitoneal anatomy to oncologic surgeons who treat patients with testis cancer requiring RPLND.
Key Reference: Beveridge TS, Power NE, et al. J Urol 2016, 196 (6), 1764
Presented By: Nicholas Power, MD
Written By: Benjamin T. Ristau, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA