Robot-assisted Retroperitoneal Lymph Node Dissection Research Articles

V09-02 ROBOT ASSISTED SALVAGE RETROPERITONEAL LYMPH NODE DISSECTION OF RETROCRURAL TERATOMA

INTRODUCTION AND OBJECTIVES:Robot assisted retroperitoneal lymph node dissection (RARPLND) for testicular cancer is emerging as a minimally invasive approach to residual retroperitoneal mass follow...

Role of robot assisted retroperitoneal lymph node dissection in metastatic malignant mesothelioma of the tunica vaginalis: Case series.

536 Background: The management of malignant mesothelioma of the tunica vaginalis of the testes (MMTVT) is not clearly defined, though retroperitoneal lymph node dissection has been reported as a diagnostic and potentially therapeutic option. Herein we present our experience with robot assisted retroperitoneal lymph node dissection (RARPLND) in a series of patients with MMTVT. Methods: The Mayo Clinic cancer registry was queried from 1972-present for all patients who had a diagnosis of MMTVT. Six patients were identified, five of whom were treated with RPLND, where four underwent RARPLND. Data was collected on pertinent demographic, preoperative, perioperative, postoperative outcomes and follow-up oncological data. Results: In five patients who underwent RPLND, the median age was 50 years (IQR 34-51), median BMI was 26.9 (IQR 26.4-30.6). Four patients originally presented with right sided symptomatic hydroceles, while one presented with right sided chronic epididymitis. Orchiectomy (one simple, two inguinal radical) was performed in three patients and hydrocelectomy in the other two patients prior to presentation. Preoperative cross-sectional imaging, including PET-CT scan in three patients, was negative for lymphadenopathy or metastasis. RARPLND was performed in 4/5 (80%) cases and concomitant hemiscrotectomy in 4/5 (80%) cases. Full bilateral template was performed in three patients and right modified template was performed in the remaining two. Median lymph node yield was 29 (IQR 22-32) and median blood loss was 275 cc (IQR 200-300). Positive retroperitoneal lymph nodes were found in 3/5 (60%) cases. Final margins of hemiscrotectomy were negative in all four cases. All patients who underwent RARPLND were discharged home on postoperative day one. One patient received four cycles of adjuvant Cisplatin and Pemetrexed. Mean follow-up was 27 months (range 2-47). No patients recurred. Conclusions: MMTVT is a very rare malignancy with high potential for retroperitoneal lymph node dissemination. Regardless of the approach, RPLND may provide both a diagnostic and therapeutic benefit, with the robotic approach affording a potentially expedited recovery.

Post-chemotherapy robot-assisted retroperitoneal lymph node dissection in non-seminomatous germ cell tumor of testis: Feasibility and outcomes of initial cases.

To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer. We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatous germ cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinical stage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss and intraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalization and postoperative complications) were noted. Pathological outcomes and postoperative radiological imaging in the 3rd month were investigated. RA-RPLND was completed successfully in all patients, and none of them required conversion to open surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of 1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratoma in 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10 months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging. No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of red blood cells in one patient (Clavien 2) and the overall complication rate was 20 percent. Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure with acceptable operative morbidity. However, this technique should be applied in centers highly experienced in robotic surgery, considering that RPLND is a surgery with fatal complications.

VE57 - Robot-assisted retroperitoneal lymph node dissection after chemotherapy in patient with retroperitoneal lymp node

VE57 - Robot-assisted retroperitoneal lymph node dissection after chemotherapy in patient with retroperitoneal lymp node

V06-06 ROBOT-ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR ADVANCED TESTICULAR CANCER

You have accessJournal of UrologyAdrenal, Testis, UTUC Oncology & More1 Apr 2018V06-06 ROBOT-ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR ADVANCED TESTICULAR CANCER Akbar Ashrafi, Hatim Thaker, Inderbir Gill, and Hooman Djaladat Akbar AshrafiAkbar Ashrafi More articles by this author , Hatim ThakerHatim Thaker More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1585AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retroperitoneal lymph node dissection (RPLND) remains a cornerstone of management in advanced testicular carcinoma. Robotic approaches have emerged as an alternative to traditional open techniques. Potential advantages of minimally invasive approaches include reduced blood loss, perioperative morbidity and length of stay as well as faster convalescence and improved cosmesis. METHODS We reviewed our series of 5 consecutive patients undergoing robot-assisted RPLND for advanced testicular cancer (Stage IIA or higher). Data was collected on operative time, estimated blood loss, intra- and postoperative complications and pathological outcomes. RESULTS Median age was 22 (22-26). Three patients had primary RPLND for Stage IIA disease and two had post-chemotherapy RPLND for residual masses (see Video). Median (range) operating time and estimated blood loss was 360 minutes (270-400) and 50mL (10-100) respectively. None of the patients required intra- or post-operative transfusions. Median node count was 27 (18-40). Median positive node count was 3 (1-5). Median time to bowel recovery and length of stay was 1 day (1-2). There were 2 minor complications (chylous ascites managed with dietary modification and deep vein thrombosis) and no gastrointestinal, genitourinary or wound complications. There were no major complications or readmissions. There were no recurrences at 6 months follow-up. CONCLUSIONS Robotic-assisted RPLND is safe and feasible for advanced testicular cancer. Our data suggests that the robotic approach minimizes surgical morbidity and reduces length of hospital stay without compromising lymph node yield or early oncological outcomes. Further follow up is required to confirm this technique long-term oncological efficacy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e662 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Akbar Ashrafi More articles by this author Hatim Thaker More articles by this author Inderbir Gill More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robot-Assisted Retroperitoneal Lymphadenectomy in Testicular Cancer Treatment: A Systematic Review.

Retroperitoneal lymph node dissection (RPLND) in testicular cancer is a documented treatment along with active surveillance and chemotherapy. This study aims to summarize the current evidence on the use of Robot-assisted RPLND (RARPLND) in comparison with the laparoscopic and open approach. A search was conducted in the existing literature focusing on reports with outcomes of RARPLND for stage I-IIB testicular tumor. Eleven studies complied with the inclusion criteria, including 116 patients. The average follow-up of 21.2 months showed no retroperitoneal recurrence. The median lymph node yield was 22.3 and the overall positive rate was 26%. Complications were encountered in 8% of the patients. The robotic approach showed similar results to the laparoscopic approach and outperformed the open procedure in perioperative parameters. Relapse-free survival, nodal yield, and complication rates during RARPLND for clinical stage I-IIB are acceptable. Further studies are required to establish these findings and determine benefit from the use of robotic approach.

Robot-assisted post-chemotherapy retroperitoneal lymph node dissection in germ cell tumor: is the single-docking with lateral approach relevant?

Surgical treatment of post-chemotherapy residual mass of germ cell tumor (GCT) may be performed in various techniques. We assess the feasibility, safety, and efficacy of single-docking with lateral approach robot-assisted retroperitoneal lymph node dissection (R-RPLND) in residual mass of GCT in our center. A retrospective review of patients undergoing R-RPLND for residual mass of CGT was performed between January 2014 and April 2017. Patients with residual mass <3cm for seminoma or <1cm for non-seminoma were eligible. All surgeries were performed with single-docking RPNLD technique in lateral decubitus. We assessed preoperative characteristics (age, testicular pathology, template, chemotherapy regimen, lesion size, and clinical stage), peroperative (operative time, estimated blood loss, intraoperative complication, node count, pathology, and number of positive node), and postoperative outcomes (postoperative complications, hospital length of stay, recurrence-free survival at 2year, and ejaculation dysfunction). Eleven patients underwent R-RPLND with a median size of the residual mass of 20mm. Median operative time was 153min with 120ml of estimated blood loss, without intraoperative complication. Median nodes count was 7 [1; 24]. Two patients had post-chemotherapy necrotic nodes and one no tumorous node. One patient had postoperative Clavien I complication (chyloperitoneum). We report 72.7% of antegrade ejaculation at 1month from the surgery. Median clinical recurrence-free survival was 100% after 2years from the surgery (n=6). Lateral approach with single-docking R-RPLND for residual mass of GCT is feasible and safe, with satisfying functional and oncologic outcomes.

Re: Singh A et al. Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer. Indian J Urol 2017;33:304-9.

Re: Singh A et al. Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer. Indian J Urol 2017;33:304-9.

VE51 - Robot-assisted Retroperitoneal Lymph Node Dissection (Ra-RPLND) for massive postchemotherapy retroperitoneal residual mass in mixed germ cell left testicular cancer: Surgical technique and intraoperative vascular complication management

VE51 - Robot-assisted Retroperitoneal Lymph Node Dissection (Ra-RPLND) for massive postchemotherapy retroperitoneal residual mass in mixed germ cell left testicular cancer: Surgical technique and intraoperative vascular complication management

PE95 - Technique, challenges, and outcomes of post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RPLND) for testicular cancer

PE95 - Technique, challenges, and outcomes of post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RPLND) for testicular cancer

Robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in the adolescent population

Robot-assisted retroperitoneal lymph node dissection (RA-RPLND) has built on success and techniques of laparoscopic RPLND, with the added benefits of robotic technology. This paper demonstrates use of the da Vinci Xi® system for RA-RPLND in two adolescent patients. Case #1: A 17-year-old male presented with a left testicular mass and elevated alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Pathology revealed a mixed non-seminomatous germ cell tumor (60% embryonal, 35% yolk sac, 5% choriocarcinoma, + lymphovascular invasion). Tumor marker normalized post-orchiectomy, and staging imaging was without evidence of metastatic disease. After discussion of options he opted to undergo RA-RPLND. Case #2: A 15-year-old male presented with a right para-testicular mass and negative tumor markers. He underwent inguinal exploration and excision of the paratesticular mass. Final pathology revealed an ectomesenchymoma with a spindle cell rhabdomyosarcoma component. Staging imaging was negative, and after discussion of options he underwent completion orchiectomy and RA-RPLND. The patient in Case #1 underwent a left modified-template nerve-sparing RA-RPLND. Sixteen lymph nodes were negative for tumor. The patient in Case #2 underwent complete bilateral nerve-sparing RA-RPLND. Forty-two lymph nodes were negative for tumor. Estimated blood loss was <50cc for both cases, and console time averaged 262min. This was a report of two cases of RA-RPLND in the adolescent population. RA-RPLND is technically feasible in this population, and further study of RA-RPLND is needed to determine long-term outcomes, as this technique is becoming more widely adopted.

Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer.

Introduction:We aimed to evaluate the surgical feasibility, complication, and oncological outcome of robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in patients of testicular tumor with postchemotherapy residual retroperitoneal mass.Methods:A total of 13 patients underwent RA-RPLND between January 2012 and September 2016 at our institute. A study was started on December 2015, so data were collected retrospectively and prospectively regarding patient demography, tumor characteristics, surgical, pathological outcome, and oncological outcome.Results:RA-RPLND was successfully completed in all the 13 patients. Lateral approach was used in initial 12 patients with unilateral dissection in 11 patients and bilateral dissection after in 1 patient after repositioning in bilateral position. Supine robotic approach used in 1 patient. Median operative time was 200 min, median estimated blood loss was 120 ml, and median length of hospital stay was 4 days. The median yield of lymph node was 20. Three patients had positive lymph nodes, all had teratoma germ cell tumor. Ten patients had only necrosis in lymph nodes. After median follow-up 23 months (range 3-58 months), no systemic or retroperitoneal recurrence was found. Four patients developed chyle leak. One patient was managed conservatively with diet modification, one with intranodal lipiodol lymphangiography and two patients were managed surgically.Conclusion:RA-RPLND is safe and feasible for postchemotherapy residual mass with accepted compilation rate, but larger studies are required to establish its diagnostic and therapeutic utility along with safety of the procedure.

Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer

BackgroundPrimary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). ObjectiveTo evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participantsBetween 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedureR-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysisData were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitationsForty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235min (interquartile range [IQR]: 214–258min), estimated blood loss was 50ml (IQR: 50–100ml), node count was 26 (IQR: 18–32), and length of stay was 1 d. There were two intraoperative complications (4%), four early postoperative complications (9%), no late complications, and the rate of antegrade ejaculation was 100%. Of the eight patients (17%) with positive nodes (seven pN1and one pN2), five (62%) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97% (95% confidence interval: 82–100%). Limitations include retrospective design and limited follow-up. ConclusionsOur multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summaryWe examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes.

MP81-16 PERIOPERATIVE AND EARLY ONCOLOGICAL OUTCOMES FOLLOWING ROBOT ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER: A MULTI-INSTITUTIONAL STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2016MP81-16 PERIOPERATIVE AND EARLY ONCOLOGICAL OUTCOMES FOLLOWING ROBOT ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER: A MULTI-INSTITUTIONAL STUDY Haidar Abdul-Muhsin, Michael Marshall, Sean Stroup, James L'esperance, Michael Woods, James Porter, and Erik Castle Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Michael MarshallMichael Marshall More articles by this author , Sean StroupSean Stroup More articles by this author , James L'esperanceJames L'esperance More articles by this author , Michael WoodsMichael Woods More articles by this author , James PorterJames Porter More articles by this author , and Erik CastleErik Castle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2069AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the perioperative outcomes and postoperative complication rates for robot assisted retroperitoneal lymph node dissection (RA-RPLND) in a large multi-Institutional cohort. METHODS After individual institutional review board approval in four participating institutions, the data of all testicular cancer patients treated with RA-RPLND at these tertiary institutions were collected and retrospectively analyzed. The procedures were performed by a single robotic surgeon at each participating institution. All demographic, Intraoperative variables, post-operative pathological outcomes and complications were reported. Additionally, Recurrence rates were reported at then end of follow up. RESULTS There were 103 patients who underwent RA-RPLND. The mean patients age was 29.6 years (SD 9.7), mean BMI was 26.4 Kg/m2 (SD 5.1). Bilateral Full template dissection was performed in 65 (63.1%) patients compared to 36 patients (35%) who had modified templates of dissection. Nerve sparing was attempted in 68 (66%) patients. There were 70 (68%) patients who underwent primary RA-RPLND compared to 33 (32%) patients who received previous chemotherapy. Mean operative time was 339 min (SD 108). Estimated blood loss was 244.1 ml (SD 486). Length of postoperative hospital stay was 2.1 days (SD 1.5). There were six conversions (5.8%) to open RPLND. Postoperatively, there were 28 total complications (Grade I=22, II=5, IIIB=1). From oncological point of view, mean lymph node (LN) yield was 24.1 LNs (SD 10.8) with positive LN identified in 35 patients (33.9%). Among the primary RARPLND, adjuvant chemotherapy was given to 21.4% (3/14) of pIIA, 50% (3/6) of pIIB and 50% of pIIC patients. There were five lung recurrences (4.8%) identified at a mean follow up of 26.9 months (SD 22.4). No in field recurrences were identified CONCLUSIONS To our knowledge this study represents the largest study of RA-RPLND outcomes in testicular cancer patients. It demonstrates that this procedure is safe and reproducible. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1059 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Haidar Abdul-Muhsin More articles by this author Michael Marshall More articles by this author Sean Stroup More articles by this author James L'esperance More articles by this author Michael Woods More articles by this author James Porter More articles by this author Erik Castle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PE04: Robot-assisted retroperitoneal lymph node dissection for metastatic testicular germ cell tumors: Safety and feasibility in the early phases of the learning curve

PE04: Robot-assisted retroperitoneal lymph node dissection for metastatic testicular germ cell tumors: Safety and feasibility in the early phases of the learning curve

Robot-assisted retroperitoneal lymph node dissection: technique and initial case series of 18 patients.

To evaluate outcomes of the first 18 patients treated with robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for non-seminomatous germ cell tumours (NSGCT) and paratesticular rhabdomyosarcoma (RMS) at our institution. Between March 2008 and May 2013, 17 patients underwent RA-RPLND for NSGCT and one for paratesticular RMS. Data were collected retrospectively on patient demographics, preoperative tumour characteristics, and perioperative outcomes including open conversion rate, lymph node (LN) yield, rate of positive LNs, operative time, estimated blood loss (EBL), and length of stay (LOS). Perioperative outcomes were compared between patients receiving primary RA-RPLND vs post-chemotherapy RA-RPLND. Medium-term outcomes of tumour recurrence rate and maintenance of antegrade ejaculation were recorded. RA-RPLND was completed robotically in 15 of 18 (83%) patients. LNs were positive in eight of 18 patients (44%). The mean LN yield was 22 LNs. For cases completed robotically, the mean operative time was 329 min, EBL was 103 mL, and LOS was 2.4 days. At a mean (range) follow-up of 22 (1-58) months, there were no retroperitoneal recurrences and two of 17 (12%) patients with NSGCT had pulmonary recurrences. Antegrade ejaculation was maintained in 91% of patients with a nerve-sparing approach. Patients receiving primary RA-RPLND had shorter operative times compared with those post-chemotherapy (311 vs 369 min, P = 0.03). There was no significant difference in LN yield (22 vs 18 LNs, P = 0.34), EBL (100 vs 313 mL, P = 0.13), or LOS (2.75 vs 2.2 days, P = 0.36). This initial selected case series of RA-RPLND shows that the procedure is safe, reproducible, and feasible for stage I-IIB NSGCT and RMS in the hands of experienced robotic surgeons. Larger studies are needed to confirm the diagnostic and therapeutic utility of this technique.

A novel “intuitive” surgical technique for right robot-assisted retroperitoneal lymph node dissection for stage I testicular NSGCT

To describe a new technique for the right template RPLND able to offer a optimal exposure of surgical field, minimal bowel mobilization, and enabling a more "openlike dissection" technique. We used a variant of the aortic lymphadenectomy previously described by Magrina et al. for gynecologic malignancies. The patient is placed in a steep Trendelenburg, supine position and the robot column, at the patient's head. The trocar position is specular to that used for RALP and known for generating no collision between the robotic arms. The node dissection of the right template, including laterocaval and interaortocaval nodes, is carried out like in the "open" split-and-roll technique. The docking time was 15', the console time was 192', the blood loss was irrelevant (50 mL), and the number of retrieved nodes was 19. The exposure of the infrarenal vein region of the operatory field resulted optimal without extensive bowel mobilization. The dissection perfectly mimicked the open procedure. As the left RPLND template includes only para-aortic lymph nodes, the left full flank position seems adequate. On the contrary, it enables a less good exposure of the more extensive right RPLND template, requiring excellent robotic surgical skills to overpass related deadlocks. On the contrary, our technique allows adequate and safe performance of the robotic. It enables a good view of the retroperitoneal space reducing the need of bowel mobilization to obtain a good exposure of the operatory field. Moreover, the patient's supine position makes the procedure more similar to the open technique.

Kommentar zur retroperitonealen Lymphadenektomie – laparoskopisch vs. robotisch

Retroperitoneal lymph node dissection (RPLND) in high risk clinical stage I nonseminomatous germ cell tumors (NSGCT) plays a limited role in modern uro-oncology due to the superior therapeutic efficacy of even one cycle of PEB (cysplatin, etoposide, bleomycin) chemotherapy. There might be an indication for the rare case of pure mature teratoma with unfavorable prognostic risk factors. If RPLND is performed for clinical stage I NSGCT it always has to be performed in a nerve-sparing technique and within the well-defined boundaries of an anatomically adequate template in order to avoid unnecessary adjuvant systemic chemotherapy. In this aspect, laparoscopic RPLND is inferior to open RPLND as basically all patients with lymph node positive disease receive adjuvant chemotherapy. The evidence for robotic-assisted RPLND is too weak to draw any clinically useful conclusions. Currently, it is an experimental procedure.Postchemotherapy RPLND (PC-RPLND) remains a surgery for tertiary referral centres due to the complexity of the surgical intervention and the high probability of adjunctive visceral and/or vascular surgery. In accordance with international guidelines it remains a domain for an open surgical approach. Laparoscopic PC-RPLND is reserved for small residual masses with the option of a unilateral modified template resection in very experienced laparoscopic centres. With regard to robotic-assisted PC-RPLND there is no evidence in the literature with regard to morbidity and complications, short-term and long-term oncological results being in favor of this experimental approach.

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

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 ...

Post-chemotherapy robotic retroperitoneal lymph node dissection (RRPLND) in testicular cancer.

We report here on the safety and feasibility of using robotic surgery for the excision of residual retroperitoneal lymph node metastasis in patients with non-seminomatous germ cell testicular tumors (NSGCT) post-chemotherapy (PC). Two men (age 20 and 21years, respectively) with residual PC retroperitoneal disease underwent robotic assisted retroperitoneal lymph node dissection (RRPLND). The primary testicular tumor was on the right testicle in one patient and on the left testicle in the other patient. Both patients had a history of testicular NSGCT and bulky retroperitoneal lymph node metastasis and had received chemotherapy. The technique, feasibility, and safety of the RRPLND procedure are reported. RRPLND was safely accomplished in both patients. A right-side approach was performed in one patient; a left-side approach was utilized in the other patient. In both patients, the field of dissection was an ipsilateral template for lymph node dissection, including excision of the residual mass. No intraoperative or postoperative complications were encountered. Pathology showed mature teratomatous elements in both patients. We demonstrate here the safety and feasibility of performing template RRPLND in patients with PC residual masses. Further reports are needed to compare this procedure to its other approaches, namely, standard open and laparoscopic RPLND.