Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer

Abstract

Introduction: We aimed to evaluate the surgical feasibility, complication, and oncological outcome of robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in patients of testicular tumor with postchemotherapy residual retroperitoneal mass.

Methods: A total of 13 patients underwent RA-RPLND between January 2012 and September 2016 at our institute. A study was started on December 2015, so data were collected retrospectively and prospectively regarding patient demography, tumor characteristics, surgical, pathological outcome, and oncological outcome.

Results: RA-RPLND was successfully completed in all the 13 patients. Lateral approach was used in initial 12 patients with unilateral dissection in 11 patients and bilateral dissection after in 1 patient after repositioning in bilateral position. Supine robotic approach used in 1 patient. Median operative time was 200 min, median estimated blood loss was 120 ml, and median length of hospital stay was 4 days. The median yield of lymph node was 20. Three patients had positive lymph nodes, all had teratoma germ cell tumor. Ten patients had only necrosis in lymph nodes. After median follow-up 23 months (range 3-58 months), no systemic or retroperitoneal recurrence was found. Four patients developed chyle leak. One patient was managed conservatively with diet modification, one with intranodal lipiodol lymphangiography and two patients were managed surgically.

Conclusion: RA-RPLND is safe and feasible for postchemotherapy residual mass with accepted compilation rate, but larger studies are required to establish its diagnostic and therapeutic utility along with safety of the procedure.

Figure 1

Port placement for robot-assisted retroperitoneal lymph node dissection in left lateral position. (a) 8 mm port for Prograsp forceps in the right iliac fossa; (b) 8 mm port for fenestrated bipolar in lower abdomen at pararectal line; (c) 12 mm port for assistance at periumbilical location; (d) 5 mm port for liver retraction in midline; (e) 8 mm port for monopolar scissor; (f) 12 mm port for camera

Figure 2

Port placement for robot-assisted retroperitoneal lymph node dissection in supine position. (a) 8 mm port for fenestrated bipolar in the right iliac fossa; (b) 12 mm port for assistance; (c) 12 mm port for camera in midline; (d) 8 mm port for monopolar scissor; (e) 8 mm port for Prograsp forceps

Figure 3

Intra-operative picture of RA-RPLND showing Aorta, lumbar Artery, and IVC

Figure 4

(a) Computed tomography abdomen multiplanar reformat demonstrating dense pooling of lipiodol at the site of chyle leak; (b) Axial section showing chyle leak in the left para-aortic region