Abstract
Current management options for low-stage malignant germ-cell testicular tumours after radical orchiectomy include surveillance, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Open RPLND is the surgical gold standard but has a number of limitations. Firstly, approximately two-thirds of patients have either necrosis/fibrosis or pathologically negative nodes. Secondly, the operation results in a large scar and significant perioperative morbidity and convalescence. Laparoscopic retroperitoneal lymph node dissection has developed as a possible alternative to the open procedure.
Currently, laparoscopic retroperitoneal lymph node dissection (L-RPLND) is not recommended as a standard therapeutic option in the European Association of Urology (EAU) guidelines. L-RPLND has, however, proved to be an excellent staging tool ,which should be developed as a less invasive alternative to primary open RPLND. As a staging tool, L-RPLND is performed usually without retrocaval or retroaortic dissection and is used to determine pathological status. The therapeutic value of this more limited dissection is not known and currently trials are underway to establish the therapeutic benefits. L-RPLND has been reported as efficacious compared to open RPLND for staging of the retroperitoneum in patients with stage I nonseminomatous germ-cell testis tumours (NSGCT). The rate of tumour control after L-RPLND and the diagnostic accuracy of L-RPLND were equal to the open procedure, and the morbidity was significantly lower [1, 2]. Therefore, L-RPLND for stage I and low-volume retroperitoneal stage II disease may be performed at experienced urology centres as part of ongoing trials [3, 4].
Loss of antegrade ejaculation is the most common long-term problem that the young men who undergo this operation experience. In an attempt to minimise this problem, either a template dissection or nerve-sparing RPLND should be performed. In a right template dissection, the right postganglionic fibres are resected whilst the left side ones are left intact. This applies to the left side also. Complete unilateral resection of the nerves should not result in loss of antegrade ejaculation. Dissection of both sides is only required in bilateral RPLND.
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© 2011 Springer-Verlag Berlin Heidelberg
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Türk, I. et al. (2011). Lympadenectomy. In: Stolzenburg, JU., Türk, I., Liatsikos, E. (eds) Laparoscopic and Robot-Assisted Surgery in Urology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-00891-7_2
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DOI: https://doi.org/10.1007/978-3-642-00891-7_2
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