V1033 ROBOT-ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION MODIFIED NERVE-SPARING LEFT SIDED TEMPLATE

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2012V1033 ROBOT-ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION MODIFIED NERVE-SPARING LEFT SIDED TEMPLATE Khurshid R. Ghani, Jay Jhaveri, Quoc-Dien Trinh, Emil Kheterpal, Jesse D. Sammon, Wooju Jeong, Shyam Sukumar, Michael Ehlert, Mani Menon, and Akshay Bhandari Khurshid R. GhaniKhurshid R. Ghani Detroit, MI More articles by this author , Jay JhaveriJay Jhaveri Detroit, MI More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Detroit, MI More articles by this author , Emil KheterpalEmil Kheterpal Detroit, MI More articles by this author , Jesse D. SammonJesse D. Sammon Detroit, MI More articles by this author , Wooju JeongWooju Jeong Detroit, MI More articles by this author , Shyam SukumarShyam Sukumar Detroit, MI More articles by this author , Michael EhlertMichael Ehlert Detroit, MI More articles by this author , Mani MenonMani Menon Detroit, MI More articles by this author , and Akshay BhandariAkshay Bhandari Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to the inherent difficulty with dissection, laparoscopic retroperitoneal lymph node dissection (RPLND) is not considered standard treatment for patients with nonseminomatous germ cell tumors. The relatively short learning curve of robotic surgery is providing a comparative advantage over laparoscopic techniques. We report our technique for robot-assisted RPLND in a patient with clinical stage I non-seminomatous testicular cancer. To our knowledge this is the first video description of a left-sided template. METHODS Our patient was a 25-year-old man who underwent a left orchiectomy for a mixed non-seminatous germ cell tumor (90% embryonal) with lymphovascular invasion (Stage 1B). Tumour markers were slightly elevated on admission. Staging CT scans were negative for nodal metastatic disease. The patient underwent a left-sided modified nerve-sparing template RPLND. The technique demonstrated is a transperitoneal 5-port approach with dissection contained to the left ureter laterally, great vessels medially, renal vein superiorly and bifurcation of common iliacs inferiorly. Hem-O-lok clips (Weck, Teleflex Medical, NC, USA) and robotic Harmonic™ device (Ethicon Endosurgery, OH, USA) were used for ligation of lymphatic channels. All lymphatic tissue was placed in an endoscopic bag and extracted via the periumbilical camera port. RESULTS Operative time was 205 minutes. Estimated operative blood loss was 110mL and the patient's post-operative hemoglobin dropped by 0.5 g/dL. The patient was discharged from the hospital postoperative day 1. The final specimen demonstrated pre-aortic, para-aortic and inter-aortocaval nodes with metastatic embryonal carcinoma in 6 of 28 lymph nodes and no evidence of extranodal extension. The patient thereafter underwent 3 cycles of Bleomycin, Etoposide and Cisplatin chemotherapy. Follow-up surveillance scans to date (12 months) do not demonstrate evidence of disease recurrence. CONCLUSIONS Robot-assisted repair of RPLND results in good lymph node yield, short hospital stay and low morbidity. New instrumentation such as the robotic Harmonic™ device is especially useful in this procedure for ligation of lymphatic channels. Analysis of larger case series is required before this technique can be compared to open RPLND. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e419-e420 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khurshid R. Ghani Detroit, MI More articles by this author Jay Jhaveri Detroit, MI More articles by this author Quoc-Dien Trinh Detroit, MI More articles by this author Emil Kheterpal Detroit, MI More articles by this author Jesse D. Sammon Detroit, MI More articles by this author Wooju Jeong Detroit, MI More articles by this author Shyam Sukumar Detroit, MI More articles by this author Michael Ehlert Detroit, MI More articles by this author Mani Menon Detroit, MI More articles by this author Akshay Bhandari Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...