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. 2025 Apr 27;17(9):1476.
doi: 10.3390/cancers17091476.

Robotic Retroperitoneal Lymph Node Dissection for Testicular Cancer-First Experience and Learning Curve of a Single Surgeon

Markus Angerer  1 , Christian Wülfing  1 , Klaus-Peter Dieckmann  1
Affiliations

Robotic Retroperitoneal Lymph Node Dissection for Testicular Cancer-First Experience and Learning Curve of a Single Surgeon

Markus Angerer et al. Cancers (Basel). .

Abstract

Background/Objectives: Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the staging and treatment of testicular cancer and is often mandatory. RPLND is associated with a high risk of morbidity. The use of minimally invasive techniques has significantly increased the number of robotic procedures performed over the last few years. This study aimed to analyze the perioperative and postoperative outcomes and trends of an increasing number of surgeries performed. Materials and Methods: We retrospectively analyzed 30 robotic RPLNDs (R-RPLNDs) performed at our testicular cancer center between 2020 and 2024. Logistic regression analyses were used to analyze the independent variables of operative time (OT), hospital stay (HS), estimated blood loss, lymph node yield, and complications according to the Clavien-Dindo classification system. The independent predictors included case number, clinical stage, post-chemotherapy status, preoperative retroperitoneal tumor mass, and body mass index. Furthermore, the patients were categorized into three groups: group A (cases 1-10), group B (cases 11-20), and group C (cases 21-30). A Kruskal-Wallis test was performed to assess differences among the groups concerning OT, HS, and lymph node yield. Results: OT significantly decreased with an increasing number of cases (p < 0.001), and HS was significantly affected by overall complications (p = 0.0006). There were two major perioperative complications (6.6%). No factors predicted overall complications or Clavien-Dindo grades I-II or III-V. The Kruskal-Wallis test showed a significant difference (p < 0.05) in OT and HS for group C. Conclusions: R-RPLND for GCTs demonstrates a clear learning curve, with significant improvements in OT, HS, and complication rates as surgeons gain experience. Overall, the low complication rates for R-RPLND did not indicate predictive factors for perioperative or postoperative complications. RPLND presents promising potential as a safe and effective treatment for GCTs, especially when performed by experienced surgeons in specialized centers.

Keywords: learning curve; retroperitoneal lymph node dissection; robotic surgery; testicular cancer.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1
Figure 1
Overview of intraoperative port placement.
Figure 2
Figure 2
Association of hospital stay with consecutive case number.
Figure 3
Figure 3
Association of operative time with consecutive case number.
Figure 4
Figure 4
Association of lymph node yield with consecutive case number.
See this image and copyright information in PMC

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