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

Luca Afferi1, Philipp Baumeister1, Christian Fankhauser1

  • 1Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.

European Urology Open Science
|October 20, 2021
PubMed
Summary

Robotic nerve-sparing unilateral template retroperitoneal lymph node dissection (RPLND) is a safe and feasible technique for testicular cancer patients. This approach achieves high lymph node yield and good functional outcomes with no short-term recurrences.

Keywords:
Lymph node dissectionMinimally invasive surgical procedureNonseminomatous germ cell tumorRetroperitoneal neoplasmSeminomaTestis cancer

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Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • Retroperitoneal lymph node dissection (RPLND) is crucial for testicular cancer management.
  • Minimally invasive techniques are explored to reduce RPLND morbidity.
  • Nerve-sparing, template, and en-bloc resections are key surgical modifications.

Purpose of the Study:

  • To detail the surgical steps of robotic nerve-sparing unilateral template RPLND with en-bloc resection (roboRPLND-NS+).
  • To evaluate the perioperative outcomes of this robotic approach.

Main Methods:

  • A lateral transperitoneal robotic approach using the da Vinci Xi system was employed.
  • Sympathetic chains and hypogastric plexus were preserved for nerve-sparing.
  • Lymph nodes within defined template borders were resected en-bloc.

Main Results:

  • The median operative time was 274 minutes, with a median of 19 lymph nodes removed.
  • Three patients had confirmed node metastases, with a median of 2 positive nodes.
  • No intraoperative or postoperative complications occurred, and all patients maintained antegrade ejaculation.

Conclusions:

  • RoboRPLND-NS+ is a safe and feasible robotic technique for testicular cancer.
  • The procedure allows for high lymph node yield and preserves functional outcomes.
  • Excellent short-term survival was observed, with no recurrences or deaths.