OBJECTIVE: To describe a laparoscopic-assisted modification to the traditional open retroperitoneal lymph node dissection (RPLND) to significantly shorten incision length and decrease morbidity of the laparotomy.
METHODS: We describe 3 patients who underwent primary RPLND using the laparoscopic-assisted cord excision for stage I nonseminomatous germ cell testicular tumors. Spermatic cord excision is performed laparoscopically, and a standard nerve-sparing bilateral template RPLND is then performed through a supraumbilical incision. Operative time, intraoperative estimated blood loss, number of lymph nodes resected, complications, length of hospital stay, and follow-up were determined.
RESULTS: All patients were clinical stage 1 (T1-2, Nx, M0 S0). The primary testicular tumor size was 2.2-5.5 cm with embryonal components, and all had negative results on abdominal and chest computed tomography imaging. Mean estimated blood loss was 267 mL (range, 100-500), operating room time was 293 minutes (range, 254-306), and all patients were discharged on postoperative day 5. There were no complications noted. Node counts were 22-33. The median length of follow-up was 20 months with no recurrence.
CONCLUSION: Laparoscopic removal of the spermatic cord during open RPLND is a simple modification to the standard technique that reduces incision size without compromising the quality of open RPLND.
Written by:
Woo JR, Liss MA, Kane CJ. Are you the author?
Department of Urology, University of California-San Diego Health System, San Diego, CA.
Reference: Urology. 2013 Oct;82(4):959-62.
doi: 10.1016/j.urology.2013.07.008
PubMed Abstract
PMID: 24074990
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