Thomas Lehner, Lesley Ann Bergmeier, in Mucosal Immunology (Third Edition), 2005 Targeted lymph node immunizationĪs an alternative strategy, a subcutaneous immunization technique was developed that aims to administer the vaccine in the proximity of the internal and external iliac lymph nodes ( Lehner et al., 1994b). Once the nerve is identified clearly, dissecting it laterally with gentle traction away from the nodal tissue is generally straightforward and ensures that the nerve remains intact. Care should be taken to secure and divide all vascular tributaries from both vessels to the psoas muscle during this maneuver. Because the nerve is frequently engulfed within the common and external iliac lymph nodes, freeing it may require a split-and-roll technique.Ĭomplete mobilization of the artery and vein medially may facilitate identification and preservation of the nerve. Dissection of the nodal tissue should start proximally at the para-aortic or paracaval nodes in an extended template. The nerve commonly lies adjacent to the common iliac vessels, in the groove between the vessels and the medial aspect of the psoas muscle ( Fig. The keys to avoiding inadvertent avulsion of the genitofemoral nerve are knowing its location and identifying it early. Genitofemoral nerve injury may occur in patients undergoing standard lymphadenectomy or extended lymphadenectomy including the common and external iliac lymph nodes. Bochner MD, in Complications of Urologic Surgery (Fourth Edition), 2010 Intraoperative Techniques to Avoid Injury The common iliac nodes receive lymphatic drainage from the internal and external groups of lymph nodes and drain into the paraaortic lymph nodes. Left-sided primaries metastasize to preaortic nodes and left paraaortic nodes just below the level of the renal vein. Right-sided testicular tumors spread initially to the aortocaval nodes, the right paraaortic nodes, and the precaval nodes. Typical patterns of spread in testicular cancer patients occur according to the side of the primary tumor. In addition, the paraaortic nodes receive drainage from the gonads. Paraaortic lymph nodes receive lymphatic drainage from the common iliac lymph nodes. More posteriorly, metabolic activity is seen in internal iliac, common iliac, and paraaortic lymph nodes. The external iliac nodes are above the inguinal ligament and are the primary drainage for the inguinal nodes. First of 3 coronal PET/CT images in the same patient diagnosed with lymphoma shows multiple enlarged metabolically active lymph nodes.

Shotty lymph nodes