Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular tumor

An appropriate laparoscopic technique for diagnostic retroperitoneal lymph node dissection in clinical Stage I testicular tumors is presented and its efficiency and morbidity are evaluated.

A two-step procedure has been developed. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised and the borders of dissection are defined. Via the ventral approach removal of retroaortic and retrocaval nodal tissue is technically not feasible. Therefore, in the second step, a lateral approach is used, which is the key to success because it permits straightforward transection of the lumbar vessels. Thus, complete lymph node dissection within the boundaries described by Weissbach can be achieved. Between August 1992 and March 1994, this procedure was performed in 15 patients. In 9 patients, the tumor was on the right side and in 6 it was on the left.

Conversion to open surgery was necessary in 2 patients because of uncontrollable bleeding and a large metastasis. Microscopic metastasis were detected in 2 other patients. Apart from the bleeding just mentioned, no major complications occurred; no blood transfusions were required.

The results obtained so far demonstrate that the technique is feasible and decreases postoperative morbidity. It therefore warrants further consideration.