Removal of pelvic and/or paraaortic lymph nodes is an integral part of surgery for gynecologic and urologic cancers. For gynecologic malignancies paraaortic lymph nodes are divided into infra- and supramesenteric relative to the bifurcation of the aorta, inferior mesenteric artery (IMA), and left renal vein (Fig. 32.1). For women with high-risk bladder cancer undergoing a radical cystectomy, the pelvic lymphadenectomy is routinely performed and is divided into limited, extended and super-extended with the proximal limit of dissection at the common iliac bifurcation, aortic bifurcation, or the base of the IMA respectively [1]. Lymphadenectomy may be performed by open or laparoscopic surgery. Major complications Pelvic and paraaortic lymphadenectomy (PPLND)complications related to pelvic and paraaortic lymphadenectomy (PPLND) include vascular injury, lymphedema, nerve injury, ureteral injury, compromise of blood supply to the intestinal tract, injury to the duodenum, arterial embolization, lymphocyst and chylous ascites.