Post-chemotherapy robotic retroperitoneal lymph node dissection (RRPLND) in testicular cancer

We report here on the safety and feasibility of using robotic surgery for the excision of residual retroperitoneal lymph node metastasis in patients with non-seminomatous germ cell testicular tumors (NSGCT) post-chemotherapy (PC). Two men (age 20 and 21 years, respectively) with residual PC retroperitoneal disease underwent robotic assisted retroperitoneal lymph node dissection (RRPLND). The primary testicular tumor was on the right testicle in one patient and on the left testicle in the other patient. Both patients had a history of testicular NSGCT and bulky retroperitoneal lymph node metastasis and had received chemotherapy. The technique, feasibility, and safety of the RRPLND procedure are reported. RRPLND was safely accomplished in both patients. A right-side approach was performed in one patient; a left-side approach was utilized in the other patient. In both patients, the field of dissection was an ipsilateral template for lymph node dissection, including excision of the residual mass. No intraoperative or postoperative complications were encountered. Pathology showed mature teratomatous elements in both patients. We demonstrate here the safety and feasibility of performing template RRPLND in patients with PC residual masses. Further reports are needed to compare this procedure to its other approaches, namely, standard open and laparoscopic RPLND.