You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2012V1034 MIDLINE EXTRAPERITONEAL APPROACH FOR RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR GERM CELL TUMOR Kenneth Faber, Sumeet Syan, and Siamak Daneshmand Kenneth FaberKenneth Faber Los Angeles, CA More articles by this author , Sumeet SyanSumeet Syan Los Angeles, CA More articles by this author , and Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retroperitoneal lymph node dissection (RPLND) for treatment of germ cell testicular tumor (GCT) can be technically difficult and associated with significant morbidity. We present a video describing a midline extraperitoneal (EP) approach that may decrease perioperative complications, particularly gastrointestinal morbidity. METHODS This video illustrates an 8-step approach for a midline extraperitoneal retroperitoneal lymph node dissection. The representative example utilizes an extended left-sided template including dissection of the inter-aortocaval nodes, with a second example of a completed extended right-sided template including the inter-aortocaval and para-arotic nodes. RESULTS Between April 2010 and October 2011, we performed 16 extraperitoneal RPLNDs, 8 were primary procedures, and 8 were post-chemotherapy. The steps outlined in the video include: 1) Midline incision from xiphoid to pubis, including incision through anterior and posterior rectus fascia; 2) Development of space between transversalis fascia and peritoneum; 3) Medial sweep of peritoneal contents off the lateral abdominal wall and posterior rectus sheath; 4) Development of plane between Gerota's fascia and the peritoneum; 5) Placement of table-fixed retractor to retract peritoneal sac and abdominal wall; 6) RPLND performed in standard fashion; 7) Application of tissue sealant; and 8) Closure. CONCLUSIONS An extraperitoneal approach to retroperitoneal lymph node dissections can be performed safely without prolonged operative times or compromised lymph node retrieval even in the post-chemotherapy setting. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e420 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth Faber Los Angeles, CA More articles by this author Sumeet Syan Los Angeles, CA More articles by this author Siamak Daneshmand Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...