{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:56:05Z","timestamp":1773788165749,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Although several clinical guidelines for prostate cancer (PC) recommend extended pelvic lymph node dissection (ePLND) during radical prostatectomy for high\u2010risk cases, there are several issues to consider, including certain technical aspects. A simplified approach to the medial internal iliac region and paravesical arteries has not been established. The uretero\u2010hypogastric nerve fascia (UHF) envelopes the ureter, hypogastric nerve, and pelvic autonomic nerves. To preserve the UHF, it is possible to approach the medial side of the internal iliac vessels without injuring any important tissue. We analyzed technical feasibility and lymph node (LN) yields.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>After obtaining institutional review board approval, 265 high\u2010risk PC patients with ePLND were identified. A da Vinci S or Xi robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used. We divided the patients into conventional (non\u2010UHF) method and modified (UHF) groups. The numbers of LNs removed, procedure\u2010related complications, and surgical outcomes were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median number of LNs removed was 19.0 in the non\u2010UHF group and 22.0 in the UHF group (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.004). Significantly more LNs were removed from the internal iliac region in the UHF group (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.042). There was no difference in overall operative, console, or LN dissection time, or the severe complication rate (Clavien\u2010Dindo grade\u2009\u2265\u2009III), between the non\u2010UHF and UHF groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our simplified approach using the UHF development technique is technically feasible, has no major complications, and allows for the removal of significantly more LNs compared with the conventional method.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.15082","type":"journal-article","created":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T13:15:30Z","timestamp":1666962930000},"page":"190-195","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Simplified approach to the medial internal iliac region using a uretero\u2010hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot\u2010assisted radical prostatectomy for high\u2010risk prostate cancer"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0407-7123","authenticated-orcid":false,"given":"Masaki","family":"Shimbo","sequence":"first","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehiro","family":"Ohyama","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumiyasu","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Komatsu","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoko","family":"Kyono","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Sano","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazutaka","family":"Narimoto","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Urology St. Luke's International Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.13380"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.08.003"},{"key":"e_1_2_13_4_1","unstructured":"SandaMG CadedduJA ChenRC CrispinoT FreedlandS GreeneK et\u00a0al.Clinically localized prostate cancer: AUA\/ASTRO\/ SUO guideline.2017.https:\/\/www.auanet.org\/guidelines\/prostate\u2010cancer\u2010clinically\u2010localized\u2010guideline. 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