Robot assisted retroperitoneal lymph-node dissection after adjuvant therapy: different indications.

Abstract

Today, access to technology through robotic surgery has allowed urologists to have a valuable tool in order to perform various robot -assisted laparoscopic procedures. Robotic surgery allows reproducing complex techniques such as retroperitoneal or extended pelvic lymphadenectomy. The aim of the study was to report our series of robot assisted retroperitoneal lymphadenectomy and to demonstrate its technical and oncological feasibility. A retrospective analysis on 7 patients (four cases of testicular tumors, one prostate adenocarcinoma, and two bladder urothelial carcinomas), who underwent retroperitoneal para-aortic, interaorto-cava and extended pelvic lymphadenectomy by robot assisted laparoscopic surgery, was conducted. We analyzed demographic, oncologic and operative data (surgical time, blood loss, and hospital stay). Demographic and operative data showed a mean age of 49 years (18-65), mean BMI of 26.1 kg/m2(23.7-29.1), mean operative time of198 minutes (180-220), mean estimated blood loss of 88 mL, and mean hospital stay of 3.6 days (3-5). No intraoperative complications occurred. Themean number of dissected nodes was 12 (3-20). Histopathology findings showed one case of postchemotherapy recurrenceof seminoma and six cases of fibrosis. At a mean postoperative follow-up of 39 months (7-75) no patients showed disease recurrence. Our case series demonstrated that the robot assisted approach isa feasible and reproducible option in skilled robotic surgical referral centers. The surgeons' experience and the optical magnification, associated to the degree of freedom offered by robotic assisted laparoscopy allow achievinga precise lymph node dissection, also in advanced oncologic patients.