V03-10 EN-BLOC ROBOTIC RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOR

Abstract

You have accessJournal of UrologyUTUC & Testis Cancer (V03)1 Apr 2020V03-10 EN-BLOC ROBOTIC RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOR James Porter* and Elliot Blau James Porter*James Porter* More articles by this author and Elliot BlauElliot Blau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000849.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open retroperitoneal lymph node dissection (RPLND) has been the gold standard in both the primary and post-chemotherapy treatment of non-seminomatous germ cell tumors (NSGCT). Of recent interest has been the safety and feasibility of utilizing a robotic-assisted (RA), minimally invasive approach. Proposed advantages to RA-RPLND include decreased morbidity and pain, shorter length of stay (LOS), improved cosmesis and similar oncologic outcomes to the open approach. There have been concerns raised as to the completeness of minimally invasive RPLND with incomplete removal of some lymphatic tissue behind the great vessels. To ensure a thorough dissection, we have developed a technique based on the en bloc removal of all lymphatic tissue within the bilateral template. In this video abstract we demonstrate our approach and technique for bilateral template RPLND utilizing an en-bloc method for extirpation of the specimen. METHODS: Our patient is a 32-year-old male with a history of mixed germ cell tumor of the right testis. He presented with elevated tumor markers and mildly enlarged lymph nodes and was initially stage IIa. He underwent BEP chemotherapy x3, with normalization of serum markers. On follow-up surveillance imaging there was evidence of retroperitoneal recurrence with a growing mass in the paraaortic region. Patient was taken for bilateral robotic RPLND. The robotic approach was performed in the supine position with the patient in Trendelenberg. Four robotic ports were placed in a linear configuration 4cm below the umbilicus and 7cm apart. A 12mm assistant port was placed in the right lower quadrant. Internal suspension sutures were used to provide exposure to the retroperitoneum. Complete en bloc removal of retroperitoneal lymph nodes was performed from the renal vessels to the bifurcation of the iliac arteries bilaterally. RESULTS: Robotic operative time was 6.5 hours. Estimated blood loss was 100cc. There were no complications. The patient was discharged to home post-operative day 1 on a low-fat diet. The specimen was removed en bloc. Pathology revealed 31 lymph nodes; 5 of these with evidence of fibrosis, 1 with viable mature teratoma measuring 4.9 cm. CONCLUSIONS: We present a technique for en bloc removal of retroperitoneal lymph nodes in a patient with a post chemotherapy mass using a supine robotic approach. The en bloc technique ensures complete removal of all lymphatics within the bilateral template including the retrocaval and retroaortic tissues. This method promotes control of lymphatic channels and avoids division of lymph nodes within the template. Robotic RPLND should be attempted in select patients by surgeons with significant experience in oncology and robotic surgery. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e282-e282 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Porter* More articles by this author Elliot Blau More articles by this author Expand All Advertisement PDF downloadLoading ...