Extraperitoneal robot-assisted laparoscopic retroperitoneal lymph node dissection for early-stage testicular nonseminomatous germ cell tumors

Qin, Jie; Wang, Ping; Jing, Taile; Kong, Deguang; Xia, Dan; Wang, Shuo

doi:10.1097/md.0000000000008938

Cited by 6 publications

(9 citation statements)

References 17 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, our study represents a small surgical series performed by a surgeon experienced in robot-assisted RPLND and the results might not be comparable to surgeons at the beginning of their learning curve. Therefore, our RPLND modifications require validation in larger studies and further modification of the surgical technique (eg, extraretroperitoneal [23] ) or the preoperative and postoperative pathways (eg, an emergency conversion checklist [24] ) should be considered.…”

Section: Discussionmentioning

confidence: 99%

Nerve-sparing Robot-assisted Retroperitoneal Lymph Node Dissection: The Monoblock Technique

Afferi

Baumeister

Fankhauser

et al. 2021

European Urology Open Science

View full text Add to dashboard Cite

Background Retroperitoneal lymph node dissection (RPLND) is a treatment option for men with stage 1 or 2 testis cancer and the standard of care for men with postchemotherapy retroperitoneal residual disease. Given the morbidity of RPLND, four important surgical modifications have been proposed: minimally invasive access, nerve-sparing resection, template resection, and en-bloc resection. Objective To describe the surgical steps and perioperative outcomes of robotic nerve-sparing unilateral template RPLND with en-bloc resection (roboRPLND-NS+). Design, setting, and participants From 2017 to 2019, five patients with suspicion of retroperitoneal metastatic testicular cancer on abdominopelvic computed tomography underwent roboRPLND-NS+ at a single referral center. All surgeries were carried out by a single surgeon who has performed more than 500 extended and more than 50 super-extended robot-assisted lymph node dissections. Surgical procedure A lateral transperitoneal robotic approach with a da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in six-arm configuration was used. The sympathetic chains, postganglionic sympathetic fibers, and hypogastric plexus were preserved as much as possible to ensure a nerve-sparing procedure. The template borders consisted of the renal vein cranially, the ureter laterally, the interaortocaval space medially, the common iliac artery caudally, and the psoas muscle dorsally for the right and left modified RPLND templates. Lymph nodes and the surrounding fatty tissue were progressively resected from the common iliac vessels and the abdominal aorta using the split-and-roll technique, and all of the template tissue was resected as a single specimen. Intraoperative and postoperative complications were recorded. Measurements Lymph node yield and perioperative and postoperative oncological and functional outcomes were measured. Results and limitations The median patient age was 38 yr (interquartile range [IQR] 32–41) and the median operative time was 274 min (IQR 238–280). Node metastases were pathologically confirmed in three patients. The median number of lymph nodes removed was 19 (IQR 18–21), and the median number of positive lymph nodes was 2 (IQR 1–3). No patient experienced intraoperative or postoperative complications. The postoperative hospital stay was either 3 or 4 d. Maintenance of antegrade ejaculation was achieved in all patients. After median follow-up of 15 mo (IQR 14–30), all patients were alive and no recurrence was observed. Limitations include the low number of patients and the single surgeon experience. Conclusions RoboRPLND-NS+ is a safe and feasible technique that allows removal of a high number of lymph nodes with good functional outcomes. Short-term survival outcomes were excellent, with no recurrences or deaths recorded. Patient summary ...

show abstract

Section: Discussionmentioning

confidence: 99%

Nerve-sparing Robot-assisted Retroperitoneal Lymph Node Dissection: The Monoblock Technique

Afferi

Baumeister

Fankhauser

et al. 2021

European Urology Open Science

View full text Add to dashboard Cite

show abstract

“…Under general anesthesia, the patient was placed in the flank position with the ipsilateral side up and secured to the operating table. A 4-port, finger- and balloon-dissecting extraperitoneal laparoscopic approach was used as previously described 7,8. A 2-cm transverse skin incision was first made over the iliac crest at the midaxillary line.…”

Section: Methodsmentioning

confidence: 99%

<p>Retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy in adult patients with duplex kidneys</p>

Qin

Wang

Jing

et al. 2019

TCRM

Self Cite

View full text Add to dashboard Cite

Background: To report our experience with retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy in adult patients with duplex kidneys. Methods: We retrospectively reviewed the medical records of 7 patients who underwent retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy at our institution between September 2014 and July 2017. Of the robot-assisted laparoscopic procedures, 5 were on the left and 2 on the right side. Results: All patients underwent robot-assisted laparoscopic surgery successfully in a totally retroperitoneal manner without conversion to open surgery. The mean operative time was 175 mins (range 140–270). The mean estimated blood loss was 84 mL (range 20–200). The mean postoperative hospital stay was 7 days (range 5–9). No major intraoperative and postoperative complications occurred. All patients had a resolution of their presenting symptoms after surgery at a mean follow-up of 24 months (range 14–38). Conclusion: Our initial clinical experience suggests that robot-assisted laparoscopic upper pole heminephrectomy using a retroperitoneal approach for a duplex kidney appears to be safe with acceptable perioperative outcomes.

show abstract

“…Overall, 271 patients underwent primary R-RPLND. Tables 1 and 2 [6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] describe the demographic and clinical characteristics and the perioperative outcomes in these patients, most of whom had NSGCT (88.9%, 241/271). Among 271 patients undergoing primary R-RPLND, 23.2% (63/271) (Table 1).…”

Section: Perioperative Outcomes After Primary R-rplndmentioning

confidence: 99%

“…The possible advantages of the extraperitoneal approach include less likelihood of injury to surrounding visceral organs, bowel paralysis, and adhesions. Extrapolating this to a robotic platform, Qin et al [30] first described the use of the extraperitoneal approach for primary R-RPLND in the flank position for Stage I right testicular NSGCT. Pooleri et al [48] reported on extraperitoneal post-chemotherapy R-RPLND in the supine position for NSGCT using the da Vinci â Xi system.…”

Section: Transperitoneal Vs Extraperitoneal Approachmentioning

confidence: 99%

Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

Garg¹,

Mansour²,

Psutka

et al. 2023

BJU International

View full text Add to dashboard Cite

To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease. Materials and MethodsThe PubMed â , Scopus â , Cochrane Central Register of Controlled Trials, and Web of Science TM databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. ResultsThe search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002). ConclusionRobot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.

show abstract

Extraperitoneal robot-assisted laparoscopic retroperitoneal lymph node dissection for early-stage testicular nonseminomatous germ cell tumors

Cited by 6 publications

References 17 publications

Nerve-sparing Robot-assisted Retroperitoneal Lymph Node Dissection: The Monoblock Technique

Nerve-sparing Robot-assisted Retroperitoneal Lymph Node Dissection: The Monoblock Technique

<p>Retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy in adult patients with duplex kidneys</p>

Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

Contact Info

Product

Resources

About