Imaging

Abstract

Urological Survey Urological Survey laparoscopic experience," the challenge of laparoscopic retroperitoneal lymph node dissection (L-RPLND) is often overlooked. I agree with the authors that a left-sided L-RPLND for Stage I nonseminomatous germ cell tumor (NSGCT) is the best way to start off. The left-sided template is smaller, the aorta is more forgiving, and the midline does not need to be crossed. There is controversy about the right-sided template, however. For those who feel that the right-sided dissection should be carried all the way to the contralateral renal hilum, completing this dissection laparoscopically without repositioning is difficult. It would have been nice if the authors had given us data on operative time, complications, and conversions for right vs. left procedures-I would guess that the right-sided ones were more challenging and dangerous. Disagreements about extent of the template aside, the authors' data are very reassuring as to the completeness of the dissection for Stage I disease. Of 91 patients with negative dissections, only one suffered a retroperitoneal recurrence. This suggests that the dissection by the authors is thorough. Certainly, their data regarding complications and conversions are excellent. L-RPLND should be considered an excellent option when there is "advanced laparoscopic experience."