V1034: Midline Extraperitoneal Approach for Retroperitoneal Lymph Node Dissection for Testicular Germ Cell Tumor

Video

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.

Funding: None