Laparoscopic retroperitoneal lymph node dissection.
Laparoscopic RPLND for clinical stage I testicular tumors is superior to open surgery in terms of efficiency, morbidity, and costs and has equal diagnostic accuracy. A quality of life study has shown that patients prefer surgery to chemotherapy and laparoscopy to open surgery. Laparoscopic RPLND is also feasible after chemotherapy, and the results are as good as those achieved in clinical stage I disease. Patients with stage IIb lesions can be spared the third and fourth cycle of chemotherapy if diagnostic laparoscopic RPLND is performed to exclude active tumor or remove mature teratoma. Laparoscopic removal of residual tumors following conventional chemotherapy for stage IIb lesions can be performed with minimal morbidity. The long and steep learning curve remains the biggest obstacle in laparoscopic RPLND. Most centers specializing in the treatment of testicular cancer are not trained in laparoscopic surgery and vice versa; however, the growing importance of laparoscopy for oncologic indications should help to overcome this problem in the near future.
Janetschek
G
G
Department of Urology, University of Innsbruck, Innsbruck, Austria. guenter.janetschek@elisabethinen.or.at
D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome