Reply

Authors

  • A. Timoney,

  • J. Parkin,

  • F. Keeley


Thank you for the opportunity to respond to Mr Ali's criticism of our paper. The last publication on the subject of laparoscopic lymph node sampling in the BJU Int concluded that laparoscopic lymph node sampling could be safely left to laparoscopic general surgeons who had experience of the regional anatomy. Some urological surgeons consider that the practice of urology should be the preserve of the urologist; our article was written in support of that view. Mr Ali seems to have missed one of the main points of the article; by carrying out laparoscopic lymph node sampling, 24% of patients in the series could be saved needless radical local treatment, whether it be radiotherapy as in this series or one of the experimental alternatives, e.g. brachytherapy or cryotherapy. Previous reports described the widespread use of laparoscopic lymph node sampling in patients who were candidates for radical prostatectomy, a practice that has fallen from favour because of the low incidence of lymph node metastases in that group of patients. Our indications are strictly limited to patients with locally advanced disease. It is true that until recently we have been one of the few British centres to regularly undertake laparoscopic urology, but there has recently been significantly increased interest in the laparoscopic approach. The first two references Mr Ali cites are both 9 years old and we felt that reporting our experiences of laparoscopic lymph node sampling was timely. Finally, Mr Ali quotes the experience of robotically assisted lymph node sampling. While one of the senior authors is a recognised advocate of the application of robotics in surgery, even he realises that their widespread use remains in the future.

Ancillary