575 Standardized robotic lateral pelvic lymph node dissection for advanced rectal cancer: a 3- zone, 2-space anatomical approach

Dr. Gomathi Meenakshi P

Locally advanced rectal cancer often presents with persistent lateral pelvic lymph nodes ≥5 mm after neoadjuvant chemoradiation, posing a significant risk for locoregional recurrence. Lateral pelvic lymph node dissection (LPLND) is a critical procedure in such cases, but it is technically challenging due to the complex neurovascular anatomy, deep pelvic location, and the need to preserve autonomic nerves to avoid postoperative dysfunction. Conventional approaches lack standardization, increasing the risk of incomplete dissection and suboptimal oncological outcomes. We propose a standardized robotic LPLND technique based on a 3-zone, 2-space anatomical approach. This method involves systematic identification of fascial planes and precise dissection of critical structures, allowing for complete lymphatic clearance while minimizing nerve injury. The innovation lies in combining advanced robotic technology with an anatomical framework, improving reproducibility, surgical precision, and patient safety. This approach ensures optimal oncological outcomes in complex rectal cancer cases.

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