PD15-08 OPEN VERSUS ROBOTIC-ASSISTED LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Malignant Disease I1 Apr 2015PD15-08 OPEN VERSUS ROBOTIC-ASSISTED LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER Kimberly Fischer, Michael Santomauro, Eric Biewenga, Justin Nork, Patrick Scarborough, Ithaar Derweesh, Sean Stroup, Erik Castle, James Porter, and James L'Esperance Kimberly FischerKimberly Fischer More articles by this author , Michael SantomauroMichael Santomauro More articles by this author , Eric BiewengaEric Biewenga More articles by this author , Justin NorkJustin Nork More articles by this author , Patrick ScarboroughPatrick Scarborough More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Sean StroupSean Stroup More articles by this author , Erik CastleErik Castle More articles by this author , James PorterJames Porter More articles by this author , and James L'EsperanceJames L'Esperance More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic-assisted laparoscopic retroperitoneal lymph node dissection (RPLND) for testicular cancer is an advanced surgical technique that has been slow to gain acceptance due to technical challenges and concerns about patient safety and oncologic equivalence. We compared robotic-assisted laparoscopic RPLND using a low-abdominal approach to the traditional open approach. METHODS We conducted a retrospective review of 93 men with non-seminomatous testicular cancer who underwent either open or Robotic-RPLND for primary or selected post-chemotherapy cases. The robotic technique was performed with patients positioned in 15 degrees of Trendelenburg. An infraumbilical camera port, 3 robotic arm ports, and 2 assistant ports were placed in a lower abdominal configuration with the robot docked over the patient's left shoulder. Hammock sutures on either side of the peritoneum retracted and elevated the small bowel, while the 3rd robotic arm retracted the duodenum anteriorly. A prospective, nerve-sparing approach was used for primary cases. Patient demographic, perioperative variables, and oncologic outcomes were assessed. RESULTS From 2009 to 2014, 58 open and 35 robotic-RPLNDs were conducted in men with non-seminomatous germ cell tumors. Demographics and operative details, including operative time, number of lymph nodes removed and complications showed no significant difference (Fig 1). Occult stage II disease in primary patients was similar between groups, 18.5% robotic vs. 23.4% open(p=0.772). The change of hemoglobin at post-operative day 1 was 2.5 [1.8-3.3] for the open group, compared to 1.3 [0.7-2.1] robotic (p=<0.001). Recovery was accelerated in the robotic group with significantly less post-operative medication use, 148.9mg [48.8-497.6] morphine equivalents open compared to 29.2mg [12-59] robotic (p=<0.001); and shorter length of stay, 6 days [4.5-7] open and 3 [3-4] days robotic (p=<0.001). CONCLUSIONS Robotic-RPLND overcomes many challenges and provides an excellent view of retroperitoneal structures. Supine positioning for robotic docking enables a thorough dissection of the retroperitoneum. These data suggest equivalent oncologic outcomes with similar operative times, while achieving significant improvement in recovery time, postoperative pain, and blood loss. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e327-e328 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kimberly Fischer More articles by this author Michael Santomauro More articles by this author Eric Biewenga More articles by this author Justin Nork More articles by this author Patrick Scarborough More a