Robot-assisted laparoscopic retroperitoneal lymph node dissection in testicular cancer using a single-position supine approach: A case report and literature review

Abstract

This case study demonstrates a single-position supine approach for robotic retroperitoneal lymph node dissection (R-RPLDN) for the treatment of nonseminomatous germ cell tumors and residual masses after chemotherapy. We performed a bilateral R-RPLDN in a 33-year-old man with nonseminomatous germ cell tumors and residual postchemotherapy masses. For this approach, the patient was placed in a steep Trendelenburg position, and a 5-port transperitoneal technique was used, with the robot docked so that the arms were oriented cephalad. This approach allowed simultaneous access to both sides of the retroperitoneum, thereby eliminating the need for bilateral lymphadenectomy and patient repositioning. Bilateral R-RPLDN was performed using a single-position supine approach. This versatile approach offers a less invasive, more efficient, and safer solution for removing residual postchemotherapy testicular cancer masses.

Keywords

Nonseminomatous germ cell tumor / Retroperitoneal lymph node dissection / Robotic surgery / Single-position supine approach

Acknowledgments

None.

Statement of ethics

This study has obtained approval from the institutional review board of The Third Xiangya Hospital, Central South University (no. 2021-S316). All patients provided informed consent for the use of their clinical information in research studies, and the confidentiality of the data was guaranteed. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflicts of interest statement

CL is an early career editorial board member of Current Urology. This article was accepted after normal external review. The other authors declare that they have no competing financial interests or personal relationships that may have influenced the work reported in this study.

Funding source

This work was supported by the Natural Science Foundation of Hunan Province (2022JJ30908) and Innovation Guidance Project of Clinical Medical Technology of Hunan Province (2021SK53710).

Author contributions

LZ, CL: Writing of the main manuscript text;

KY, WX: Preparation of Fig. 1 and 5;

LW: Preparation of Figs. 3-4;

WH, BW: Preparation of Fig. 2;

LX: Preparation of Table 1;

All authors: Review of the manuscript.

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

References

[1] Albers P, Albrecht W, Algaba F, et al. Guidelines on testicular cancer: 2015 update. Eur Urol 2015; 68(6):1054-1068.

[2] Haugnes HS, Bosl GJ, Boer H, et al. Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up. J Clin Oncol 2012; 30(30):3752-3763.

[3] Tandstad T, Ståhl O, Håkansson U, et al. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 2014; 25(11):2167-2172.

[4] Singh A, Chatterjee S, Bansal P, Bansal A, Rawal S. Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer. Indian J Urol 2017; 33(4):304-309.

[5] Rukstalis DB, Chodak GW. Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol 1992; 148(6):1907-1909; discussion 1909-1910.

[6] Nicolai N, Miceli R, Necchi A, et al. Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours: Long-term outcome and analysis of risk factors of recurrence. Eur Urol 2010; 58(6):912-918.

[7] Hiester A, Nini A, Arsov C, Buddensieck C, Albers P. Robotic assisted retroperitoneal lymph node dissection for small volume metastatic testicular cancer. J Urol 2020; 204(6):1242-1248.

[8] Davol P, Sumfest J, Rukstalis D. Robotic-assisted laparoscopic retroperitoneal lymph node dissection. Urology 2006; 67(1):199.

[9] Tamhankar AS, Patil SR, Ojha SP, Ahluwalia P, Gautam G. Therapeutic supine robotic retroperitoneal lymph node dissection for post-chemotherapy residual masses in testicular cancer: Technique and outcome analysis of initial experience. J Robot Surg 2019; 13(6):747-756.

[10] Ray B, Hajdu SI, Whitmore WF Jr. Proceedings:Distribution of retroperitoneal lymph node metastases in testicular germinal tumors. Cancer 1974; 33(2):340-348.

[11] Donohue JP, Zachary JM, Maynard BR. Distribution of nodal metastases in nonseminomatous testis cancer. J Urol 1982; 128(2):315-320.

[12] Weissbach L, Boedefeld EA. Localization of solitary and multiple metastases in stage II nonseminomatous testis tumor as basis for a modified staging lymph node dissection in stage I. J Urol 1987; 138(1):77-82.

[13] Kamel MH, Littlejohn N, Cox M, Eltahawy EA, Davis R. Post-chemotherapy robotic retroperitoneal lymph node dissection: Institutional experience. J Endourol 2016; 30(5):510-519.

[14] Cheney SM, Andrews PE, Leibovich BC, Castle EP. Robot-assisted retroperitoneal lymph node dissection: Technique and initial case series of 18 patients. BJU Int 2015; 115(1):114-120.

[15] Stout TE, Soni SD, Goh AC. Post-chemotherapy robotic bilateral retroperitoneal lymph node dissection using a novel single-dock technique. J Robot Surg 2016; 10(4):353-356.

[16] Stepanian S, Patel M, Porter J. Robot-assisted laparoscopic retroperitoneal lymph node dissection for testicular cancer: Evolution of the technique. Eur Urol 2016; 70(4):661-667.

[17] Pooleri GK, Bijalwan P, Kesavan R, Philip A, Keechilat P. Robot-assisted supine extraperitoneal retroperitoneal lymph node dissection: A novel approach for template dissection in post-chemotherapy residual mass in non-seminomatous germ cell tumours. J Robot Surg 2019; 13(1):171-173.

[18] Nason GJ, Kuhathaas K, Anson-Cartwright L, et al. Robotic retroperitoneal lymph node dissection for primary and post-chemotherapy testis cancer. J Robot Surg 2022; 16(2):369-375.

[19] Glaser AP, Bowen DK, Lindgren BW, Meeks JJ. Robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in the adolescent population. J Pediatr Urol 2017; 13(2):223-224.

[20] Klaassen Z, Hamilton RJ. The role of robotic retroperitoneal lymph node dissection for testis cancer. Urol Clin North Am 2019; 46(3):409-417.

[21] Mittakanti HR, Porter JR. Robotic retroperitoneal lymph node dissection for testicular cancer: Feasibility and latest outcomes. Curr Opin Urol 2019; 29(2):173-179.

[22] Mittakanti HR, Porter JR. Robot-assisted laparoscopic retroperitoneal lymph node dissection: A minimally invasive surgical approach for testicular cancer. Transl Androl Urol 2020; 9(Suppl 1):S66-S73.

[23] Schermerhorn SMV, Christman MS, Rocco NR, et al. Learning curve for robotic-assisted laparoscopic retroperitoneal lymph node dissection. J Endourol 2021; 35(10):1483-1489.