V08-03 FULL-TEMPLATE PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION WITH DAVINCI SINGLE PORT ROBOT

Abstract

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-03 FULL-TEMPLATE PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION WITH DAVINCI SINGLE PORT ROBOT John Sheng, Chrystal Chang, Gregory Lovallo, and Mutahar Ahmed John ShengJohn Sheng More articles by this author , Chrystal ChangChrystal Chang More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retroperitoneal lymph node dissection (RPLND) can be employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. Open RPLND has long been the standard approach but is associated with significant morbidity. Laparoscopic RPLND was developed to mitigate the morbidity associated with the open procedure, but is technically challenging requiring significant experience with laparoscopic dissection and suturing. Robotic RPLND has gained traction in recent years as an alternative, with better instrument dexterity and visualization compared to laparoscopic RPLND. The DaVinci single port robot, released by Intuitive in 2018, further advances minimally invasive surgery through one 25mm port. Here, we demonstrate the feasibility of using the single port robot technology to perform a full template RPLND for testis cancer through a single small incision. METHODS: 21 year old male with no significant past medical history underwent a left radical orchiectomy for a testicular mass. The final pathology showed mixed germ cell tumor with lymphovascular invasion. His CT scan showed subcentimeter lymphadenopathy in the retroperitoneum. Given his options of surveillance, chemotherapy or primary retroperitoneal lymph node dissection (RPLND), the patient elected to undergo primary RPLND with the single port robot. RESULTS: Patient underwent single port robotic assisted laparoscopic bilateral retroperitoneal lymph node issection. A single 25mm incision was made infraumbilically for the robotic instruments. No assistant port was used, making this a true single port procedure. The remotely operated suction irrigation system (ROSI) was used not only for suction but for dissection as well. The operative time for this case was 202 minutes. Estimated blood loss was 50cc. The patient was discharged within 18 hours of surgery with no need for post op narcotic use. CONCLUSIONS: The single port, in our experience, appears to show excellent mobility, visibility and control and allows us to perform this complex procedure in an even more minimally invasive way. Performing a robotic RPLND with the single port may allow for better cosmesis and less post operative pain which are important to many patients in this younger demographic affected by testis cancer. While there is a learning curve with the SP robot, we show that it is possible to be done safely and effectively. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e601-e602 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sheng More articles by this author Chrystal Chang More articles by this author Gregory Lovallo More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...