Laparoscopic Retroperitoneal Lymph Node Dissection Research Articles

Robot-assisted laparoscopic retroperitoneal lymph node dissection in testicular cancer using a single-position supine approach: A case report and literature review

Abstract This case study demonstrates a single-position supine approach for robotic retroperitoneal lymph node dissection for the treatment of nonseminomatous germ cell tumors and residual masses after chemotherapy. We performed a bilateral robotic retroperitoneal lymph node dissection in a 33-year-old man with nonseminomatous germ cell tumors and residual postchemotherapy masses. For this approach, the patient was placed in a steep Trendelenburg position, and a 5-port transperitoneal technique was used, with the robot docked so that the arms were oriented cephalad. This approach allowed simultaneous access to both sides of the retroperitoneum, thereby eliminating the need for bilateral lymphadenectomy and patient repositioning. Bilateral R-RPLDN was performed using a single-position supine approach. This versatile approach offers a less invasive, more efficient, and safer solution for removing residual postchemotherapy testicular cancer masses.

324 The Learning Curves of Major Laparoscopic and Robotic Procedures in Urology: A Systematic Review

Abstract Aim Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. Defining the learning curves for these procedures enables assessment of trainee performances relative to expected progress and has important implications in research. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures. Method In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 for eligible studies alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale (NOS) to then undertake quality assessment of the included articles. The review was reported in accordance with AMSTAR guidelines. Results Of 3702 records identified, 97 eligible studies were included for narrative synthesis. 39 studies evaluated robot-assisted laparoscopic prostatectomy (RALP) with the learning curve identified as 10-250 cases for operative time and 250-300 for potency. The shortest learning curve was reported for hand-assisted laparoscopic nephrectomy, involving 4-10 cases. There was considerable variation in the study designs, outcome measures and prior experience of surgeons, with all studies scoring either 5 or 6 on the NOS. Conclusions Standardised reporting of outcomes and performance measures is required to reduce heterogeneity and enable the undertaking of a meta-analysis. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection.

The role of robotic retroperitoneal lymph node dissection in testicular cancer: a systematic review and meta-analysis.

To compare the safety and efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus non-robotic retroperitoneal lymph node dissection in testicular cancer. The statistical analysis software used Stata 17. The weighted mean difference (WMD) represents the continuous variable, and the dichotomous variable chooses the odds ratio, and calculates the 95% CI. This systematic review and cumulative meta-analysis was performed according to PRISMA criteria, and AMSTAR guidelines (assessing the methodological quality of systematic reviews). The Embase, PubMed, Cochrane Library, Web of Science, and Scopus databases were searched. The upper limit of the search time frame was February 2023, and no lower limit was set. Seven studies involving 862 patients. Compared with open retroperitoneal lymph node dissection, RA-RPLND appears to have a shorter length of stay [WMD=-1.21, 95% CI (-1.66, -0.76), P <0.05], less estimated blood loss [WMD=-0.69, 95% CI (-1.07, -0.32), P <0.05], and lower overall complications [odds ratio=0.45, 95% CI (0.28, 0.73), P <0.05]. RA-RPLND appears to have more lymph node yields than laparoscopic retroperitoneal lymph node dissection [WMD=5.73, 95% CI (1.06, 10.40), P <0.05]. However, robotic versus open/laparoscopic retroperitoneal lymph node dissection had similar results in operation time, lymph node positivity rate, recurrence during follow-up, and postoperative ejaculation disorders. RA-RPLND appears to be safe and effective for testicular cancer, but longer follow-up and more studies are needed to confirm this.

Comparison of the perioperative outcomes of laparoscopic and open retroperitoneal lymph node dissection for low-stage (stage I/II) testicular germ cell tumors: a systematic review and meta-analysis.

Comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors. The authors performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17. There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay [weighted mean difference (WMD)=-3.99, 95% CI: -4.80 to -3.19, P <0.05], less estimated blood loss (WMD=-0.95, 95% CI: -1.35 to -0.54, P <0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI: -1.50 to -0.03, P <0.05), and lower overall complications (odds ratio=0.58, 95% CI: 0.38-0.87, P <0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (odds ratio=0.24, 95% CI: 0.11-0.55, P <0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up. L-RPLND is superior to O-RPLND and is worthy of clinical promotion.

Retroperitoneal lymph-node dissection (RPLND) as upfront management in stage II germ-cell tumours: Evaluation of safety and efficacy.

Patients with stage II germ-cell tumours (GCT) usually undergo radiotherapy (seminoma only) or chemotherapy. Both strategies display a recognised risk of long-term side effects. We evaluated retroperitoneal lymph node dissection (RPLND) as exclusive treatment in stage II GCT. Between 2008 and 2019 included, 66 selected stage II GCT patients underwent primary open (O-) or laparoscopic (L-)RPLND. Type of procedure and extent of dissection, operative time, node rescue, hospital stay, complications (according to Clavien-Dindo), administration of chemotherapy, relapse and site of relapse were evaluated. Five patients had pure testicular seminoma. Nineteen (28.8%) had raised markers prior to RPLND; 48 (72.7%), 16 (24.2%) and two (3.0%) were stage IIA, IIB and IIC, respectively. O-RPLND and unilateral L-RPLND were 36 and 30 respectively. Six stage II A patients (12.5%) had negative nodes. Four patients underwent immediate adjuvant chemotherapy. One patient was lost at follow-up. After a median follow-up of 29 months, 48 (77.4%) of the 62 patients undergoing RPLND alone remained recurrence-free; one patient had an in-field recurrence following a bilateral dissection. According to procedure, number of rescued nodes (O-RPLND: 25. IQR 21-31; L-RPLND: 20, IQR 15-26; p: 0.001), hospital stay (L-RPLND: 3 days, IQR 3-4; O-RPLND: 6 days, IQR 5-8; p: .001) and grade ≥2 complications (L-RPLND 7%, O-RPLND 22%; p: 0.1) were the only significant differences. Primary RPLND is safe in stage II GCT, including seminoma, and may warrant a cure rate greater than 70%. When feasible, L-RPLND may be as effective as O-RPLND with better tolerability.

Vigilance is key: Metastatic teratoma in an enlarging retroperitoneal mass after treatment of advanced seminoma – a case report

We present the case of a patient with pure seminoma in the orchiectomy specimen with retroperitoneal mass and a minimally elevated alpha fetoprotein (AFP). The patient received chemotherapy with positron emission tomography (PET) imaging demonstrating minimal fluorodeoxyglucose (FDG) uptake consistent with no viable tumour. Subsequent imaging revealed slow growth in the residual mass with a mildly elevated fluctuating AFP. A robotic-assisted laparoscopic retroperitoneal lymph node dissection was performed revealing metastatic teratoma. This case illustrates the potential for a missed or ‘burned out’ occult NSGCT in a patient with pure seminoma and the importance of post-treatment surveillance. In advanced seminoma, PET may be used to distinguish viable tumour from necrosis in post-chemotherapy residual masses. However, it is unable to distinguish between teratoma and necrosis in non-seminomatous germ cell tumours (NSGCT). Minimally elevated AFP could be a normal variant or signify a component of NSGCT in such cases. Level of evidence: 4

A0562 - Surgical and oncological outcomes of post chemotherapy laparoscopic retroperitoneal lymph node dissection in stage IIA-III non seminomatous germ-cell tumors

A0562 - Surgical and oncological outcomes of post chemotherapy laparoscopic retroperitoneal lymph node dissection in stage IIA-III non seminomatous germ-cell tumors

SC235 - Perioperative outcomes of post chemotherapy laparoscopic retroperitoneal lymph node dissection in stage IIA-III non seminomatous germ-cell tumors

SC235 - Perioperative outcomes of post chemotherapy laparoscopic retroperitoneal lymph node dissection in stage IIA-III non seminomatous germ-cell tumors

SC234 - Robotic-assisted laparoscopic retroperitoneal lymph node dissection for residual tumors after chemotherapy in testicular cancer

SC234 - Robotic-assisted laparoscopic retroperitoneal lymph node dissection for residual tumors after chemotherapy in testicular cancer

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

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 ...

Laparoscopic retroperitoneal lymph node dissection versus open retroperitoneal lymph node dissection for testicular cancer: A comparison of clinical and perioperative outcomes

ObjectiveThis study was performed to evaluate the clinical and perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) performed by one surgeon at a single center. MethodsWe evaluated 30 patients with stage IIA germ cell tumors who underwent retroperitoneal lymph node dissection (15 underwent L-RPLND and 15 underwent O-RPLND) at our institution between April 1, 2010 and March 31, 2018. The clinical parameters were compared between patients who underwent L-RPLND using the retroperitoneal approach and those who underwent O-RPLND using the transperitoneal approach. There were no significant differences in the background characteristics of the two groups except for the median follow-up duration (46 months for L-RPLND and 71 months for O-RPLND, p=0.02). ResultsL-RPLND was associated with a shorter mean operative time (mean 222 min for L-RPLND vs. 453 min for O-RPLND, p<0.001). There was significantly less blood loss during surgery in the L-RPLND group compared to the O-RPLND group (mean 165 mL for L-RPLND vs. 403 mL for O-RPLND, p<0.001). Parameters related to postoperative recovery were significantly better for the L-RPLND group than for the O-RPLND group. There were no differences in the histopathological characteristics between the two groups. No patients in either group exhibited disease recurrence. ConclusionPatients who underwent L-RPLND had more rapid recovery, and shorter hospital stay compared to those who underwent O-RPLND; complications were comparable between the two groups. L-RPLND is an efficient procedure with the benefits of minimally invasive surgery.

Post-chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ Cell Testicular Tumors.

Retroperitoneal lymph node dissection (RPLND) is performed to treat residual disease following chemotherapy for stage II and III testicular cancer. Significant morbidity can be associated with open RPLND. As such, laparoscopic techniques have been demonstrated to be safe and effective in select cases. Outcomes following post-chemotherapy laparoscopic RPLND for mixed malignant germ cell testicular tumors (MMGCT) are limited in the literature. We performed a retrospective chart review for patients who underwent laparoscopic RPLND at our institution for MMGCT from May 2006 to October 2016. Patient clinical data and perioperative and oncologic outcomes were recorded. Twenty-three patients underwent post-chemotherapy laparoscopic RPLND. Thirty-five percent (8/23) underwent bilateral template dissection, whereas 65% (15/23) underwent a modified unilateral template dissection. Robotic assistance was utilized in 22% (5/23) of cases. Bilateral template was inferior to unilateral template RPLND in operative time, estimated blood loss, open conversion rate, length of hospital stay, and complication rate. The mean follow-up was 35.1 months and 43.3 months for the bilateral and unilateral template groups, respectively. The mean lymph node yield and recurrence rate were similar between the 2 cohorts. One recurrence of mature teratoma was noted 67 months after unilateral laparoscopic RPLND. In select patients, laparoscopic RPLND for stage II and III MMGCT is safe and effective in the post-chemotherapy setting. Bilateral template laparoscopic RPLND was associated with inferior perioperative outcomes, but similar oncologic outcomes compared with unilateral template. Patients requiring bilateral template RPLND should be considered for an open approach.

Primary and post-chemotherapy robotic retroperitoneal lymph node dissection for testicular cancer: a review.

Open retroperitoneal lymph node dissection (RPLND) is the gold standard for surgical management of the retroperitoneum in patients with testicular cancer, and is associated with excellent oncologic outcomes and significant morbidity including length of stay. Minimally invasive RPLND, starting with laparoscopic retroperitoneal lymph node dissection in 1992 and now robotic retroperitoneal lymph node dissection in 2006, endeavor to decrease the morbidity of open RPLND while maintaining excellent oncologic outcomes. This review surveys the literature regarding both primary and post-chemotherapy robotic RPLND, emphasizing that while early outcomes are promising, much work needs to be done before widespread use of this technique is implemented.

Robot-assisted laparoscopic retroperitoneal lymph node dissection: a minimally invasive surgical approach for testicular cancer

Retroperitoneal lymph node dissection (RPLND) can been employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. Open RPLND (O-RPLND) has long been the standard approach for lymphadenectomy, but is associated with significant morbidity. Laparoscopic RPLND (L-RPLND) was developed to mitigate the morbidity associated with O-RPLND, but is a technically challenging procedure requiring significant experience with laparoscopic dissection and suturing to remove lymph nodes behind the great vessels and to control vascular injury. Robotic RPLND (R-RPLND) has gained traction in recent years as an alternative to both O-RPLND and L-RPLND. With superior instrument dexterity and better visualization compared to L-RPLND, and with decreased morbidity, compared to O-RPLND, R-RPLND can be performed safely and effectively. With the latest advances in robotic technology, one can perform a full bilateral dissection without needing to reposition the patient or redock the robot. R-RPLND has been applied for both primary treatment as well as in patients with post-chemotherapy residual abdominal masses.

Robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy for metastatic mixed testicular germ cell cancer: a case report

BackgroundThe robot-assisted laparoscopic management of post-chemotherapy retroperitoneal metastasis and inferior vena cava tumor thrombus secondary to testicular cancer is a challenging task for urologists.Case presentationA pathological examination of a 36-year-old Caucasian man who had undergone a right radical orchiectomy showed mixed testicular germ cell cancer (70% embryonal cancer and 30% seminoma); he had undergone four prior courses of cisplatin, etoposide, and bleomycin chemotherapy and was found to have residual retroperitoneal enlarged lymph nodes close to the right renal hilum and a 9.8 cm inferior vena cava tumor thrombus (pT1, N2, M1, S2). Pre-surgical three-dimensional image reconstruction was performed based on contrast computed tomography data. The inferior vena cava tumor thrombus was found in the vena cava at the level of the celiac trunk and the inferior mesenteric artery.Our patient accepted treatment with robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and cava reconstruction on September 12, 2018. During the procedure, a drop-in robotic ultrasound probe was used to define the thrombus. Vena cavoscopy using a flexible ureteroscope found that the tumor thrombus adhered to the cava wall in all directions. The tumor thrombus was dissected free from the inferior vena cava lumen, and vena cava reconstruction was achieved using the da Vinci™ Si HD surgical system.The operative time was 550 minutes. The intraoperative estimated blood loss was 2300 ml. Intraoperative blood transfusions consisted of 10 units of red blood cells (Clavien-Dindo grade II). No Clavien-Dindo grade III or above perioperative complications occurred. The length of hospital stay was 7 days. Pathology revealed no viable cancer cells in any of the residual lymph node tissues or in the vena cava tumor thrombus. ConclusionThis is the first case of robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and reconstruction for metastatic mixed testicular germ cell cancer published to date. This complicated surgical procedure was facilitated by the innovative usage of three-dimensional image reconstruction for defining the vena cava tumor thrombus, a robotic ultrasound probe for intraoperatively defining the vena cava tumor thrombus, and vena cavoscopy using a flexible ureteroscope.

Robotic retroperitoneal lymph node dissection for testicular cancer: feasibility and latest outcomes.

Robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) is gaining acceptance as an alternative to open and laparoscopic RPLND for the treatment of testicular cancer. We discuss the current state of R-RPLND and summarize the latest relevant literature regarding the feasibility of this operation. R-RPLND has been utilized effectively for both treatment of high-risk, clinical stage I testicular cancer as well as in the postchemotherapy setting. The feasibility of R-RPLND has been established with complication rates comparable to open RPLND and with decreased postoperative hospital stay and blood loss. As R-RPLND continues to evolve and experience grows in high-volume centers, more information will be gained regarding long-term oncologic outcomes. Ultimately, head-to-head trials comparing R-RPLND to open RPLND will be needed to determine the role of R-RPLND in the treatment of testicular cancer.

MP26-14 ROBOT ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION OF POST CHEMOTHERAPY RESIDUAL MASS – A SINGLE CENTER EXPERIENCE OF 18 PATIENTS

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2018MP26-14 ROBOT ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION OF POST CHEMOTHERAPY RESIDUAL MASS – A SINGLE CENTER EXPERIENCE OF 18 PATIENTS AMITABH SINGH, Jiten Jaipuria, Saroj Baidya, Raghubir Bhardwaj, JALAJ JAIN, and Sudhir Rawal AMITABH SINGHAMITABH SINGH More articles by this author , Jiten JaipuriaJiten Jaipuria More articles by this author , Saroj BaidyaSaroj Baidya More articles by this author , Raghubir BhardwajRaghubir Bhardwaj More articles by this author , JALAJ JAINJALAJ JAIN More articles by this author , and Sudhir RawalSudhir Rawal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.872AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retroperitoneal lymph node dissection (RPLND) is a well-established treatment for post chemotherapy residual mass in non-seminomatous germ cell tumor (NSGCT) as it has diagnostic as well as therapeutic advantage. Although the open RPLND is gold standard, but due to high postoperative morbidity and poor cosmesis due to long midline abdominal incision laparoscopic retroperitoneal lymph node dissection (L-RPLND), robot assisted laparoscopic retroperitoneal lymph node dissection(RA-RPLND) has been described. The proposed advantages of RA-RPLND are good cosmesis, shorter hospital stay, less post-operative pain and reduced compilation rate. We describe our experience of robot assisted retroperitoneal lymph node dissection (RA-RPLND) and comparison to historic cohort of L- RPLND in terms of surgical, pathological and oncological outcome. METHODS A total of 18 patients underwent RA - RPLND between September 2011 to September 2017 in our Institute. Study was started on January 2015 so data were collected retrospectively and prospectively regarding demography of patients, tumor characteristic, surgical, pathological and oncological outcomes. Short term and medium term outcomes were also recorded RESULTS Mean age of patients was 28 years and mean body mass index was 21.51 kg/m2. RA - RPLND was successfully completed in all 18 patients. Mean console time, estimated blood loss and length of hospital stay were 180.78 min, 207.89 ml and 4.31 days respectively. The mean yield of lymph node was 20. Matted lymph nodal mass was found in 4 patients and one patient had only single large retroperitoneal para-aortic mass of size 8.5x6x4.5 cm. In 10 patients modified RPLND was done and in 1 patient only large para-aortic post chemotherapy mass was excised. Out of 18 patients, 15 patients underwent nerve preserving RPLND. Only 12 patients of nerve preserving RPLND have antegrade ejaculation. Histopathological examination revealed necrosis in 14 patients whereas mature teratoma was noticed in 4 patients with one of these showing sarcomatoid differentiation too. After mean follow up period of 19.5 months, no retroperitoneal recurrence was reported. 6 patients developed chyle leak in immediate post-operative period, of these 2 patients were managed conservatively with dietary modification and octreotide, 2 patients underwent lymphangiogram and embolization and another 2 patients underwent exploratory laparotomy and ligation of cysterna chyli. CONCLUSIONS RA - RPLND is safe and feasible for post chemotherapy residual mass with acceptable complication rate. Ours is a largest reported series till date. In literature authors have mentioned series of 7-8 cases. Though larger studies are required to establish its diagnostic and therapeutic utility © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e342 Advertisement Copyright & Permissions© 2018MetricsAuthor Information AMITABH SINGH More articles by this author Jiten Jaipuria More articles by this author Saroj Baidya More articles by this author Raghubir Bhardwaj More articles by this author JALAJ JAIN More articles by this author Sudhir Rawal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retroperitoneal surgery in the treatment of germ-cell tumors of the testis: retroperitoneal lymph node dissection (RPLND)

Germ-cell tumors of the testis (GCTT) are rare, but have a high social impact. In fact they represent no more than 1% of male tumors (about 700 new cases per year in Italy), but electively occur in young patients, 20 to 40 years old, during their fully mature social and working life. More than 80% of patients are cured and return to a normal social, sexual, and working life. Improvements achieved both in diagnosis, with the use of scans (CT, MRI, US and recently PET) and of serum tumor markers alpha-fetoprotein (AFP), beta-fraction of human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH), and mainly in treatment, through the amelioration of radiotherapy and surgical techniques and, especially, with the introduction of Cisplatin, Etoposide and Ifosfamide in chemotherapic regimens, have made germ-cell tumor a model of "curable disease". Retroperitoneal lymph node dissection (RPLND) has indications in patients with clinical stage I (CS1) as well as in advanced disease, where it is integrated in the multimodality treatment. Anatomical studies, as well as a long-term experience, have gradually but consistently modified the surgical techniques of RPLND. Currently, "nerve sparing" RPLND represents a safe management of CS1 nonseminomatous germ cell testicular tumor with minimal morbidity and excellent outcomes. Nonetheless, surveillance and adjuvant chemotherapy are as effective as RPLND, but, in our opinion, associated with some discomforts for the patients. Laparoscopic retroperitoneal lymph node dissection (Lap-RPLND) is gaining popularity as a minimally invasive staging procedure for clinical stage I nonseminomatous testicular carcinoma, but its therapeutic role is still under investigation.

A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer.

Objectives The robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) represents a new frontier in the surgical management of testicular cancer in the realm of minimally invasive urologic oncology. We aimed to review the early outcomes as compared to the laparoscopic and open approaches as well as describe the operative technique for the R-RPLND. Materials and Methods We reviewed all the literature related to the R-RPLND based on an electronic PubMed search up until July 2017. Results and Discussion Encouraged by favorable early oncologic and safety outcomes for treatment of clinical stage (CS) I nonseminomatous germ cell tumor (NSGCT), the R-RPLND affords the same recovery advantages as the laparoscopic retroperitoneal lymph node dissection (L-RPLND) while offering greater dexterity, superior visualization, and a theoretically shorter learning curve for the surgeon. While R-RPLND has a promising future in the management of patients with primary and postchemotherapy NSGCT, larger and more vigorous prospective studies are needed before supplanting the open RPLND as the gold standard approach for primary low-stage NSGCT or becoming an equivalent surgical modality in the postchemotherapy setting.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Mar 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.11.109AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Growth kinetics of small renal masses on active surveillance: variability and results from the DISSRM Registry. J Urol2018; 199: 641. Link, Google Scholar 2 : Natural history of complex renal cysts: clinical evidence supporting active surveillance. J Urol2018; 199: 633. Link, Google Scholar 3 : A double-blind, randomized trial on the efficacy and safety of hyperbaric oxygenation therapy in the preservation of erectile function after radical prostatectomy. J Urol2018; 199: 805. Link, Google Scholar 4 : Development of a 90-minute integrated noninvasive urinary assay for bladder cancer detection. J Urol2018; 199: 655. Link, Google Scholar 5 : Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. J Urol2018; 199: 760. Link, Google Scholar 6 : Health related quality of life following radical cystectomy: comparative analysis from the Medicare Health Outcomes Survey. J Urol2018; 199: 669. Link, Google Scholar 7 : Natural history and predictors of parastomal hernia after robot-assisted radical cystectomy and ileal conduit urinary diversion. J Urol2018; 199: 766. Link, Google Scholar 8 : Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: safety and efficacy analyses at a high volume center. J Urol2018; 199: 741. Link, Google Scholar 9 : Multicenter analysis of patient reported outcomes following artificial urinary sphincter placement for male stress urinary incontinence. J Urol2018; 199: 785. Link, Google Scholar 10 : Fistulous complications following radical cystectomy for bladder cancer: analysis of a large modern cohort. J Urol2018; 199: 663. Link, Google Scholar 11 : Trends in prostate cancer incidence rates and prevalence of prostate specific antigen screening by socioeconomic status and regions in the United States, 2004 to 2013. J Urol2018; 199: 676. Link, Google Scholar 12 : Cycling, and male sexual and urinary function: results from a large, multinational, cross-sectional study. J Urol2018; 199: 798. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 3March 2018Page: 583-585 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...