Robot-assisted retroperitoneal lymph node dissection: technique and initial case series of 18 patients

Abstract

ObjectiveTo evaluate outcomes of the first 18 patients treated with robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for non-seminomatous germ cell tumours (NSGCT) and paratesticular rhabdomyosarcoma (RMS) at our institution. Patients and MethodsBetween March 2008 and May 2013, 17 patients underwent RA-RPLND for NSGCT and one for paratesticular RMS. Data were collected retrospectively on patient demographics, preoperative tumour characteristics, and perioperative outcomes including open conversion rate, lymph node (LN) yield, rate of positive LNs, operative time, estimated blood loss (EBL), and length of stay (LOS). Perioperative outcomes were compared between patients receiving primary RA-RPLND vs post-chemotherapy RA-RPLND. Medium-term outcomes of tumour recurrence rate and maintenance of antegrade ejaculation were recorded. ResultsRA-RPLND was completed robotically in 15 of 18 (83%) patients. LNs were positive in eight of 18 patients (44%). The mean LN yield was 22 LNs. For cases completed robotically, the mean operative time was 329 min, EBL was 103 mL, and LOS was 2.4 days. At a mean (range) follow-up of 22 (1-58) months, there were no retroperitoneal recurrences and two of 17 (12%) patients with NSGCT had pulmonary recurrences. Antegrade ejaculation was maintained in 91% of patients with a nerve-sparing approach. Patients receiving primary RA-RPLND had shorter operative times compared with those post-chemotherapy (311 vs 369 min, P = 0.03). There was no significant difference in LN yield (22 vs 18 LNs, P = 0.34), EBL (100 vs 313 mL, P = 0.13), or LOS (2.75 vs 2.2 days, P = 0.36). ConclusionThis initial selected case series of RA-RPLND shows that the procedure is safe, reproducible, and feasible for stage I-IIB NSGCT and RMS in the hands of experienced robotic surgeons. Larger studies are needed to confirm the diagnostic and therapeutic utility of this technique.

Management of Stage I Nonseminomatous Germ Cell Tumors

“…[61][62][63][64] Although technically feasible, these procedures should adhere to well-honed surgical principles, which should not be compromised in the interest of expediency.…”

Minimally Invasive Retroperitoneal Lymphadenectomy

“…The first series of 3 consecutive patients were published by Williams and colleagues, 68 who performed a modified template approach in NSGCT CS I patients. The initial series of PC-RLA done by robot-assisted laparoscopy was published by Cheney and colleagues, 69 in which bilateral RLA was done without repositioning in 18 patients (8 PC-RLA and 10 RLA). After a follow-up of 22 months, no retroperitoneal recurrences were found.…”

The Role of Postchemotherapy Surgery in Germ Cell Tumors

“…At a median on 27 months, there were no recurrences. Cheney and colleagues 54 recently published on 8 patients undergoing robotic PC-RPLND. Two patients (25%) were converted to open procedures.…”