Michael G. Santomauro, MD, Sean P. Stroup, MD, Audry H. L’Esperance, BS, James H. Masterson, MD, Ithaar H. Derweesh, MD, Brian K. Auge, MD, Donald S. Crain, MD, and James O. L’Esperance, M.D
Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA (Drs Santomauro, Stroup, Masterson, Auge, Crain, J. L’Esperance, and Ms A. L’Esperance). Division of Urology, University of California, San Diego, CA, USA (Drs Stroup and Derweesh).
Background and Objectives: Robotic-assisted laparoscopic retroperitoneal lymph node dissection (RPLND) using a lower abdominal approach for testicular cancer is an advanced and relatively new surgical technique. Herein we describe technical modifications, review benefits, and report our initial series.
Methods: A retrospective review of 16 patients from Jan 1, 2010 to Dec 31, 2012 who underwent robotic RPLND for nonseminomatous germ cell tumors was performed. Patients were positioned in 15° of Trendelenburg and tilted 15° to the right. An infraumbilical midline camera port, 3 robotic ports, and 2 assistant ports were placed in a lower abdominal configuration. Patient demographic and perioperative outcomes were assessed.
Results: Twelve patients underwent staging, prospective nerve-sparing RPLNDs, and 4 underwent postchemotherapy RPLNDs. Mean age was 26.4 years with a mean body mass index of 27.4 kg/m2. The cohort had a mean operative time of 357 minutes, mean estimated blood loss of 205 mL, mean hospital stay of 3.6 days, and mean postoperative morphine equivalent use of 47.1 mg. There were no conversions to open RPLND in this cohort. An average of 26.2 lymph nodes were sampled.
Conclusions: Inferior approach for robotic RPLND enables a thorough dissection of the retroperitoneum, without repositioning, to meet oncologic goals. Further study to evaluate long-term outcomes is warranted.
Key Words: Retroperitoneal lymph node dissection, Robotic surgery, Surgical approaches, Technical modifications, Testicular cancer.