Laparoscopic Retroperitoneal Lymph Node Dissection: Extraperitoneal Approach
We review our early experience with laparoscopic retroperitoneal lymph node dissection (RPLND) via extraperitoneal approach to assess the precise pathological status of retroperitoneal lymph nodes in early-stage testicular cancer. A total of 32 patients (23 with stage I, 4 with stage IIa, and 5 with stage IIb) with testicular cancer underwent extraperitoneal laparoscopic RPLND in the supine position. After developing the sufficient retroperitoneal space, the modified unilateral retroperitoneal lymph node dissection was performed. For stage I cases, a gamma probe guided laparoscopic RPLND was performed. The mean operating time for laparoscopy was 209 min (median 222, range 131–372 min). Mean blood loss was 44ml (median 10, range scarce to 260 ml). There was no open conversion. Two patients had prolonged lymph drainage (more than 7 days). One had a symptomatic lymphocyst treated with laparoscopic fenestration. In one case, a segmental renal infarction was noted after the operation. In 13 recent cases, the ipsilateral lumbar sympathetic nerves relevant to ejaculation were preserved and functional preservation was confirmed by intraoperative electrostimulation. Micrometastasis was found in three of clinical stage I and one of stage IIA disease. Extraperitoneal laparoscopic RPLND is technically feasible and decreases postoperative morbidity.
KeywordsTesticular cancer Retroperitoneal lymph node dissection Extraperitoneal laparoscopy Sentinel lymph node Gamma probe
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- 10.Van Leeuwen FE, Stinggebout AM, Van Den Belt-Dusebout AW, Noyon R, Eliel MR, Van Kerkhoff EH, Delenmarre JF, Somers R (1993) Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol 11:2286–2287Google Scholar
- 21.LeBlanc E, Caty A, Dargent D, Querleu D, Mazeman E (2001) Extraperitoneal laparoscopic para-aortic lymph node dissection for early-stage nonseminomatous germ cell tumors of the testis with introduction of a nerve sparing technique: description and results. J Urol 165:89–92CrossRefPubMedGoogle Scholar
- 25.Gill IS, Clayman RV, Albala DM, Aso Y, Chiu AW, Das S, Donovan JF, Fuchs GJ, Gaur DD, Go H, Gomella LG, Grune MT, Harewood LM, Janetschek G, Knapp PM, McDougall EM, Nakada SY, Preminger GM, Puppo P, Rassweiler JJ, Royce PL, Thomas R, Urban DA Winfield HN (1998) Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective. Urology 52:566–571PubMedGoogle Scholar