Pelvic Lymph Node Dissection

(note to mac users. You may have to manually switch between Male and Female data sets. The pulldown menu is above the right window. Start with the female and switch to the male when instructed.)

Pelvic nodes that are typically harvested lie betweeen the external iliac vessels and the obturator vessels. For some cancers (e.g., uterine and cervix CA) harvesting the nodes can be curative.

Goal: To examine:

- Vessels and nerves that serve as landmarks or are placed at risk by the lymph node dissection.

Let's begin with the skeleton and key ligaments. (At any time you can rotate the image or add or subtract structures. Clicking the link will always bring you back to a starting point. Remember to use rollovers to see the labels for the various structures. Also, by moving the axial plane to any point in the image on the right, you can see the cross-section on the lower left. You can add or remove the plane by pressing "Ctrl p". Any coloration in the right image will be shown in the cross-sections.)

- The image has been rotated to 330 degrees, but you can change this at any time to any angle. Use "Ctrl p" at any time to see the plane that the cross-section corresponds to.

Let's add the iliopsoas muscle to one side, as a reference . Now add in the external iliac and femoral vessels .

The lymph nodes are harvested between the external iliacs and the internal iliac-obturator vessels. The surgeon needs to protect the ureters, so let's get those in there.

One approach to the lymph nodes is to separate the iliac vessels from the iliopsoas muscle to enter the retroperitoneal plane. This places the genitofemoral nerve (not seen) and the deep circumflex artery at risk.

A large lymph node is often found by the deep inguinal ring. A guide to this location is the round ligament of the uterus.

(For the male pelvis, this guide would be the vas deferns).

A structure that would be placed at risk includes the obturator obturator nerve.

(For the male pelvis, we can identify some of the pelvic lymph nodes.)

©2007 Lawrence Rizzolo, Yale School of Medicine