Robot-assisted Retroperitoneal Lymph Node Dissection for testicular cancer is a fairly new process in the UK.
For many years RPLND has been an open surgery that carry some risk all be it very successful long term, it does how however take some time to recover and carry some risk long term.
Robotic RPNLD has been common in the United States and Germany for many years and now the UK is increasing access to this treatment.
The pro's to Robotic RPNLD are,
Its less evasive
shorter recovery time
Decreased chance of infection
P3-6 Robot-assisted Retroperitoneal Lymph Node Dissection for testis cancer: moving from feasible to mainstream
Archie Fernando1, Dr Fairleigh Reeves1, Akinlolu Oluwole-Ojo1, Raj Nair1, Yasmin Abu Ghanem1, Sarah Rudman2, Lesley Cooper1, Hema Verma3, Tim O’Brien1, Ben Challacombe1
1The Urology Centre, Guy’s Hospital, Guy’s and St Thomas’ NHS Trust, London, United Kingdom, 2Oncology Department, Guy’s Hospital, Guy’s and St Thomas’ NHS Trust, London, United Kingdom, 3Radiology Department, Guy’s Hospital, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
In the field of testis cancer robotic retroperi- toneal lymph node dissection (R-RPLND) is emerging as an alternative to open surgery but is recognised as highly com- plex surgery. Lateral and supine approaches to R-RPLND have been described. The supine approach allows bilateral dissection without the need to reposition the patient. Patients and Methods: Retrospective review of R-RPLND operations undertaken between Jan 2017-December 2021. All operations were performed by one of two consultant surgeons (AF/BC) using a da-Vinci Xi System.
32 patients (2017: 2, 2019: 3, 2020: 8, 2021: 19), aged 21-61 years. Cases 1-5 were performed lateral and cases 6-32 supine. 21/32 (65%) had residual mass post- chemotherapy & 11/32 (35%) were chemotherapy-naïve. Mean preoperative PET/CT lesion size was 27mm. Mean
nodal yield was 13 for lateral and 25 for supine.
Mean operative time was 280 minutes (range 120-420) and estimated blood loss was 128mls (range 20-600).
There were no open conversions, major vascular injuries or returns to theatre for bleeding. Complications included one secondary haemorrhage (day 15) managed by embolisation and 5 lymph leaks - 1 requiring radiological drain, 2 needing read- mission.
Mean length of stay was 2 days (range 1-4). 3/32 cases had a positive margin. Histology: 12 differentiated teratoma, 8 necrosis/benign, 10 active tumour, and 2 mixed teratoma/active tumour. Functional and medium-term oncological outcomes are awaited.
Conclusion: R-RPLND is a very challenging technique but appears feasible with excellent nodal yields & manageable complication rates. It requires detailed pre-operative planning, pragmatic case selection, and advanced robotic skills.