Robot-assisted laparoscopic retroperitoneal lymph node dissection: a minimally invasive surgical approach for testicular cancer.

Retroperitoneal lymph node dissection (RPLND) can been employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. Open RPLND (O-RPLND) has long been the standard approach for lymphadenectomy, but is associated with significant morbidity. Laparoscopic RPLND (L-RPLND) was developed to mitigate the morbidity associated with O-RPLND, but is a technically challenging procedure requiring significant experience with laparoscopic dissection and suturing to remove lymph nodes behind the great vessels and to control vascular injury. Robotic RPLND (R-RPLND) has gained traction in recent years as an alternative to both O-RPLND and L-RPLND. With superior instrument dexterity and better visualization compared to L-RPLND, and with decreased morbidity, compared to O-RPLND, R-RPLND can be performed safely and effectively. With the latest advances in robotic technology, one can perform a full bilateral dissection without needing to reposition the patient or redock the robot. R-RPLND has been applied for both primary treatment as well as in patients with post-chemotherapy residual abdominal masses

Robotic retroperitoneal lymph node dissection for testicular cancer: feasibility and latest outcomes.

PURPOSE OF REVIEW: Robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) is gaining acceptance as an alternative to open and laparoscopic RPLND for the treatment of testicular cancer. We discuss the current state of R-RPLND and summarize the latest relevant literature regarding the feasibility of this operation. RECENT FINDINGS: R-RPLND has been utilized effectively for both treatment of high-risk, clinical stage I testicular cancer as well as in the postchemotherapy setting. The feasibility of R-RPLND has been established with complication rates comparable to open RPLND and with decreased postoperative hospital stay and blood loss. SUMMARY: As R-RPLND continues to evolve and experience grows in high-volume centers, more information will be gained regarding long-term oncologic outcomes. Ultimately, head-to-head trials comparing R-RPLND to open RPLND will be needed to determine the role of R-RPLND in the treatment of testicular cancer

Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis.

PURPOSE: When performing robotic nephron-sparing surgery (NSS) for renal tumors, either a transperitoneal approach or retroperitoneal approach can be utilized. The operative technique for robotic retroperitoneal partial nephrectomy (RPPN) is discussed and a matched-paired analysis comparing both RPPN and transperitoneal partial nephrectomy (TPPN) at a single institution is discussed. MATERIALS AND METHODS: A retrospective review over a 10-year period (2006-2016) was performed for all patients who underwent robotic partial nephrectomy. A total of 281 patients underwent RPPN and 263 patients underwent TPPN. A matched-paired analysis was performed on 166 pairs of patients and the outcomes reviewed. RESULTS: Operative time (p \u3c 0.001) and estimated blood loss (p \u3c 0.001) were significantly less in the RPPN group compared to the TPPN group. No differences (p \u3e 0.05) were seen with regard to complexity of cases, warm ischemia time, tumor pathology, positive margin rates, complications, or kidney function post-operatively. CONCLUSIONS: Robotic RPPN and TPPN can both be used for NSS with good results. RPPN, when used appropriately, can lead to shorter operative times, less blood loss and equivalent oncologic and post-operative outcomes. Surgeon comfort and expertise will help determine which approach to use