V6-02: Post Chemotherapy Robotic Retroperitoneal Lymph Node Dissection for Non-Seminomatous Germ Cell Tumor
Retroperitoneal lymph node dissection (RPLND) is indicated for patients with non-seminomatous germ cell tumor (NSGCT) who have completed a primary regimen of chemotherapy and have a residual retroperitoneal mass greater than 1 cm with normal tumor markers. In the post chemotherapy (PC) setting, previous series have reported on the benefits of robotic retroperitoneal lymph node dissection (R-RPLND) with reduced morbidity, reduced hospital stay, and comparable nodal yield when compared to the open approach.
We present the technique of R-RPLND using both the daVinci Si and Xi robot. The supine approach is preferable to a lateral approach as it allows a full bilateral dissection to be performed from one position without the need to re-dock or reposition the patient. Nerve sparing technique is performed in patients undergoing bilateral dissection. There is significant reaction and fibrosis surrounding the residual retroperitoneal mass after chemotherapy and special considerations include the complete resection of the adherent mass, avoidance and control of vascular injuries, and nerve sparing techniques.
All patients were diagnosed with NSGCT and had completed 3-4 cycles of BEP. They were noted to have residual retroperitoneal mass with normal tumor markers. Mean operative time was 339. Mean estimated blood loss was 125cc. Mean number of lymph nodes excised was 28. There were no transfusions and no open conversions. Pathology showed benign fibrosis and necrosis in two (50%), teratoma in two (50%), and no viable germ cells were found.
R-RPLND in the PC setting is feasible and offers patients the benefits of a minimally invasive approach. The robotic approach, while technically challenging, offers the ability to perform bilateral template dissections and repair vascular injuries if encountered.