With robotic technology, most minimally invasive RPLND are performed with robotic assistance as this technology allows better control and more precise dissection around important vascular structures and the nerves that control ejaculation. Johns Hopkins was one of the pioneering institutions in minimally invasive RPLND, performing over 100 laparoscopic RPLNDs since 1992. Minimally Invasive RPLNDĪ minimally-invasive RPLND involves the use of small incisions and instruments to perform an RPLND. For these patients, a post-chemotherapy RPLND is often indicated to remove cancer not adequately treated by chemotherapy. In other patients, shrunken lymph nodes will slowly grow, indicating that viable cancer or a teratoma may be growing in the retroperitoneum. In some patients, the lymph nodes will shrink, but not totally disappear. Many patients with lymph node metastases, especially those with seminoma, will receive chemotherapy. In addition, minimally invasive RPLND can be performed for patients with suspicion of low-burden lymph node metastases (clinical stage II) in the hopes of avoiding chemotherapy.
Minimally invasive RPLND changes the thought process for CSI testis cancer, as it changes the ratio of risk to benefit as the morbidity associated with the procedure is dramatically reduced compared with traditional open surgery. RPLND has fallen out of favor with many physicians and organization due to the morbidity of the procedure and high risk of overtreatment. However, upwards of 70% of patients will never need an RPLND and are overtreated by surgery. RPLND was a mainstay of therapy for clinical stage I non-seminomatous germ cell tumors (NSGCT) as it better staged disease and offered a therapeutic benefit for many patients. More recently, minimally invasive RPLND has become an option for men with testis cancer, dramatically reducing the convalescence of the operation and offering the benefits of avoiding chemotherapy and rigorous AS. Traditionally, RPLND is done through a large, midline incision (along the entire abdomen) and only performed at high-volume centers of excellence due to the rarity of disease and technical challenges of the surgery. Therefore, retroperitoneal lymph node dissection (RPLND) is an important surgical option for men with testis cancer. The primary landing zone for metastases from testis cancer is the lymph nodes of the retroperitoneum - the area around and between the aorta and inferior vena cava at the level of the kidneys. Therefore, testis cancer has a very predictable pattern of spread. RationaleĪs the testicles form and develop near the kidneys in a fetus, the blood supply, lymphatic drainage and nerves to the testicle originate near the kidney on that side. Template dissection limits for left-sided tumors consist of ureter (lateral), midpoint of vena cava (medial), bifurcation of iliac vessels (distal) and renal hilum (superior). A.Template dissection limits for right-sided tumors consist of ureter (lateral), midpoint of aorta (medial), bifurcation of iliac vessels (inferior) and renal hilum (superior).
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