Laparoscopic Lymph Node Dissection or Lymphadenectomy (removal of abdominal lymph nodes)

A. The Condition. You may have a condition that produces enlarged lymph nodes within your abdomen. The lymph nodes by themselves usually do not cause a problem, but your doctors may want them removed to help diagnose or treat your underlying problem. The cause of the enlarged lymph nodes can be one of many disorders, such as a cancer.

B. Symptoms. As indicated above, the condition that you might have can be one of many, so there are no specific symptoms that go along with this procedure. You may have undiagnosed abdominal pain, weight loss, or cancer. If you are male, then you might have testicular or prostate cancer which is causing the enlarged lymph nodes.

C. Laparoscopic Lymph Node Dissection. The surgeon will make about 3-4 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the enlarged lymph nodes. These nodes typically run along the major blood vessels in your abdomen, so the surgery is performed very carefully. The nodes are placed into a plastic bag, and then removed from the abdomen through one of the small incisions. After this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

D. Nonsurgical Treatment. Sometimes a biopsy of an enlarged lymph node may be taken by a radiologist with a needle. But if your doctors want all the lymph nodes out, then surgical removal will be the best way.

E. Risks. The primary risks of laparoscopic lymph node dissection are:

• Infection of the skin at one of the small ports sites
• Injury to a major blood vessel, such as the aorta or vena cava
• Bleeding
• Bowel injury
• Postoperative ileus (the intestines slow down/stop working for several days)
• Small bowel obstruction (kinking of the small bowel, causing blockage)

F. Expectations

1. Before Your Operation. Laparoscopic lymph node dissection usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, a, endoscopy (looking down your throat with a scope), a nuclear medicine scan, an MRI scan, and/or an abdominal CT scan. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 1-3 days after a laparoscopic lymph node dissection. You may need to wait until your bowels start working. You will be given medication for pain. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• High fever
• Severe abdominal pain
• Odor or increased drainage from your incision
• No bowel movements for three days