V03-12 ROBOTIC-ASSISTED LAPAROSCOPIC RPLND FOR PARATESTICULAR RHABDOMYOSARCOMA USING 5 MM INSTRUMENTS IN PEDIATRIC SETTING

Abstract

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-12 ROBOTIC-ASSISTED LAPAROSCOPIC RPLND FOR PARATESTICULAR RHABDOMYOSARCOMA USING 5 MM INSTRUMENTS IN PEDIATRIC SETTING Angeline Johny, Vinaya Bhatia, Alan Hsieh, Jeffrey White, and Chester Koh Angeline JohnyAngeline Johny More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , Alan HsiehAlan Hsieh More articles by this author , Jeffrey WhiteJeffrey White More articles by this author , and Chester KohChester Koh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The primary objective of this video is to demonstrate that the robotic approach using 5 mm instruments for primary retroperitoneal lymph dissection (RPLND) in the pediatric patient population with paratesticular rhabdomyosarcoma (PT-RMS) is an effective and safe procedure with favorable oncologic outcomes. Patients greater than 10 years of age with PT-RMS are often under staged and under treated. Additionally, the incidence of micrometastases has been shown to be as high 40%. Micrometastases is not amenable to chemotherapy and as such, the current US recommendation is for patients who are ten years and older with PT-RMS to undergo an ipsilateral retroperitoneal lymph node dissection regardless of radiographic findings. Following initiation of these guidelines, studies have demonstrated that ipsilateral RPLNDs have improved overall survival to 86%. METHODS: In this video, two case presentations were discussed demonstrating both left and right unilateral RPLND templates. For our left template, the patient is an 11 year old male with unremarkable history who presented with one month history of enlarging left hemiscrotum and work-up notable for elevated LDH of 577. He underwent a left radical inguinal orchiectomy with final pathology demonstrating a spindle cell RMS variant with positive margins. For our right template, the patient is a 10 year old male with history of Wiskott-Aldrich Syndrome with associated thrombocytopenia who also presented with a large painless right scrotal mass. Work-up was notable for LDH of 1012. He underwent a right radical inguinal orchiectomy with final pathology demonstrating Embryonal RMS with spermatic cord, tunic, and epididymal. Both patients underwent a primary robotic RPLND using 5 mm instruments and tolerated the procedure well, with favorable immediate post operative and long term oncologic outcomes. RESULTS: To approach our template adequately, we planned the following port placement: an 8 mm camera port at the superior margin of the umbilicus, two 5 mm robotic ports in the midline, with one inferior to the xiphoid, and the second inferior to the umbilicus but superior to the bladder. The assistant port was placed in the right versus left lower quadrant depending on the laterality of the RPLND. This port placement permits visualization of the renal hilar vessels, the great vessels, the sympathetic nerve trunks, as well as the ureter and major pelvic vessels, and was modified from techniques already described by Cost et al. 2012. CONCLUSIONS: Robotic assisted RPLND enables urologists to easily and safely to apply the benefit of minimally invasive surgery with 5 mm instruments. The major advantages of the robotic approach include reduced morbidity and mortality with preserved oncologic outcomes, enhanced visualization, and heightened instrument precision. Barriers to wide spread utilization of this technique include steep learning curve, need for proctor to oversee procedure, as well as cost. Nonetheless, our video demonstrates that the advantages of using 5 mm robotic instrument ports during a primary RPLND in the pediatric setting are technically feasible, with enhanced clinical and oncologic outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e225-e226 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angeline Johny More articles by this author Vinaya Bhatia More articles by this author Alan Hsieh More articles by this author Jeffrey White More articles by this author Chester Koh More articles by this author Expand All Advertisement Loading ...