Pelvic lymphadenectomy

1.Position the patient supine.
2.Make an incision along the line of the fibres of the external oblique 3-4cm above the inguinal ligament.
3.Divide muscle down to the transversalis fascia but not through peritoneum.
4.Identify and ligate the inferior epigastric vessels.
5.Sweep the peritoneum and abdominal contents in a cephalad direction using a gauze pack and secure them out of the way using moist packs.
6.Identify and preserve the ureter which should remain adherent to the peritoneum.
7.Begin dissecting lymphatic tissue from the external iliac vessels at the inguinal ligament cephalad to the common iliac and then downwards along the internal iliac, being careful not to injure the internal iliac vein.
8.All lymphatic tissue should be removed from the inverted V of the iliacs down to the obturator foramen/vessels.
9.Close the defect in the femoral canal using 2/0 prolene.
Lavage and close in layers.