V10-02: Robotic Retroperitoneal Lymph Node Dissection for Stage 1 Non-Seminomatous Testicular Cancer: Technically Feasible with Left and Right Modified Templates
VideoIntroductions and Objectives
Robotic retroperitoneal lymph node dissection (RPLND) has not become widespread in current practice due to technical challenges. We report our experience for left and right sided node dissections for Stage 1 non-seminomatous germ cell tumors (NSGCT). Our step-by-step approach removes many of the technical challenges and allows for excellent oncologic outcomes with less morbidity compared to traditional RPLND.
We present 2 cases of robotic RPLNDs for Stage 1 NSGCT, one on the left and another on the right. The patient is placed in the flank position with the bed flexed and in slight Trendelenberg. Camera and robotic ports were placed near the midline and two assistant ports were also utilized to assist with the dissection. The robot is docked perpendicular to the patient to facilitate adequate exposure and dissection along all major vessels.
Operative times were 180 minutes and 200 minutes for the left and right sides respectively. 20 nodes were harvested on the left and 17 nodes on the right. Estimated blood loss was 50 cc and 25 cc respectively. Both patients did well and were discharged on post-operative day 1 without perioperative complications.
Preventative RPLND in Stage 1 NSGCT can be performed robotically with full adherence to open oncologic principles. Our description of this technique allows for safe and meticulous dissection and removes many of the technical challenges previously described with robotic RPLND.