Optimisation of fluorescence guidance during robot-assisted laparoscopic sentinel node biopsy for prostate cancer.
Despite the widespread use of prostate-specific antigen in the early detection of prostate cancer (PCa), the number of patients with pathologically positive lymph nodes at radical prostatectomy (RP) remains substantial [1–3]. It is well known that the larger the extension of pelvic lymphadenectomy, the greater the chance of finding a positive node [1– 4]. In addition, the overall number of positive nodes found in a single patientwill typically increase alongwith the total number of nodes removed [1,4,5]. This being said, it has been suggested that the key element influencing the number of nodes removed during pelvic lymphadenectomy has less to do with the technique used (open, laparoscopic, or robotic assisted) than with the scientific beliefs of the surgeon performing the procedure. In other words, a skilled surgeon can remove a large quantity of pelvic and retroperitoneal nodes in any PCa patient, regardless of the technique used . Although we do not yet have level 1 evidence suggesting that the number of nodes removed during RP and pelvic lymph node dissection affects cancerspecific and/or overall survival, data have been accumulating to suggest that a thoroughly performed lymphadenectomy represents a pillar of the multimodal approach to patients with high-risk PCa [2,3,7]. In this month’s issue of European Urology, KleinJan et al. report on a new technical modification of the sentinel node biopsy procedure used in patients with PCa who are at risk for nodal metastases . We have been strong supporters of technical innovations that may ultimately represent a major advance in the level of care offered to our patients. The authors are commended for performing a welldesigned study in an area, sentinel node biopsy, that remains of interest for a number of different cancers.