V8-03: Robotic Retroperitoneal Lymph Node Dissection for Clinical Stage I Testis Cancer: Technique and Outcomes
VideoIntroductions and Objectives
Retroperitoneal lymph node dissection (RPLND) is a well-established treatment option for patients with clinical stage I non-seminomatous germ cell tumor (NSGCT). Previous reports of pure laparoscopic RPLND demonstrated promising results but a steep learning curve prevented increased utilization. In this context, we present our technique and experience with robotic RPLND for clinical stage I NSGCT.
Patients are given a limited mechanical bowel preparation and an upadated CT scan is obtained the week prior to surgery. Patients are positioned in full flank position with the tumor side up. Robotic port positioning is similar to robotic renal surgery, with 2 12-mm assistant ports and a 4th robotic arm. No intraoperative re-positioning is necessary. Our surgical technique consists of wide bowel mobilization and lateral retraction of the ureter to open up the anatomic landing zone. Split and roll manuevers on the ipsilateral iliac vessels facilitate exposure of the corresponding great vessel. The 4th arm or an assistant can elevate the aorta or vena cava, allowing access to retrocaval, retroaortic, and interaortocaval spaces.
Early experience with robotic RPLND for clinical stage I NSGCT suggests safety and feasibility. Adequate nodal yield appears to reflect good access to all major anatomic landing zones. Larger experiences with longer follow-up are necessary to evaluate oncologic outcomes, especially in node-positive patients