A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Abstract

Objectives The robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) represents a new frontier in the surgical management of testicular cancer in the realm of minimally invasive urologic oncology. We aimed to review the early outcomes as compared to the laparoscopic and open approaches as well as describe the operative technique for the R-RPLND. Materials and Methods We reviewed all the literature related to the R-RPLND based on an electronic PubMed search up until July 2017. Results and Discussion Encouraged by favorable early oncologic and safety outcomes for treatment of clinical stage (CS) I nonseminomatous germ cell tumor (NSGCT), the R-RPLND affords the same recovery advantages as the laparoscopic retroperitoneal lymph node dissection (L-RPLND) while offering greater dexterity, superior visualization, and a theoretically shorter learning curve for the surgeon. While R-RPLND has a promising future in the management of patients with primary and postchemotherapy NSGCT, larger and more vigorous prospective studies are needed before supplanting the open RPLND as the gold standard approach for primary low-stage NSGCT or becoming an equivalent surgical modality in the postchemotherapy setting.

Robot-assisted retroperitoneal lymphadenectomy: The state of art

“…The robotic approach to RPLND was subsequently described to reach the same oncologic efficacy of O-RPLND while minimizing the morbidity associated with the procedure and decreasing the long learning curve related to the pure laparoscopic technique [ 6 , [8] , [10] ]. The robotic approach, with better ability from the wristed instruments, facilitates the control and suturing of the great vessels in case of injury, clearly improving the safety of the procedure [ 1 ]. As a result, multiple series of R-RPLND have been successfully reported recently in multiple experienced centers around the world, showing the potential of this surgical approach to increase the number of well-trained surgeons performing minimally invasive RPLND [ 10 , 11 , [13] , [14] , [15] , [16] , [17] , [18] ].…”

“…Testicular germ-cell tumor (GCT) is the most common solid neoplasms in young male adults between 20 and 44 years old [ 1 ]. Although sometimes only the orchiectomy itself is sufficient for cure when there are risk factors associated with occult metastatic disease in clinical stage (CS) I, possible subsequent treatments may be required [ 2 ].…”

“…After the properly evolution of multimodal treatments, the overall survival rate achieved 98% [ 1 ]. Therefore, efforts have to be made in reducing morbidity and long-term toxicity for testicular cancer survivors [ 3 ].…”

Testicular Cancer—Surgical Treatment

“…Testicular germ cell tumor (GCT) is the most common solid tumor in men between the ages of 20 and 44. Men diagnosed with GCT have excellent survival rates due to advances in the multimodal treatment paradigm of chemotherapy, radiation therapy, and surgery (1).…”

“…Moreover, the R-RPLND offers greater dexterity, superior visualization, a shorter learning curve for the surgeon and less complications overall, while still providing better recovery advantages compared to the L-RPLND, such as shorter length of stays in hospitals and reduced complication rates. However, larger prospective studies are still required to better evaluate long-term oncologic outcomes and complication rates in both the primary and post-chemotherapy settings (1).…”