title: Anterior extraperitoneal approach to laparoscopic retroperitoneal lymph node dissection: a novel technique.
abstract: OBJECTIVE
  We describe a novel technique of laparoscopic retroperitoneal lymph node dissection via an anterior extraperitoneal approach.
  
  
  METHODS
  With the patient in a modified flank position an 8 mm. incision is made along the lateral border of the ipsilateral rectus muscle at the umbilical level. Extraperitoneal space creation with finger dissection is initially made at this site and adequately enlarged with a balloon dilator, followed by gas insufflation and placement of 4 laparoscopic trocars. Laparoscopic retroperitoneal lymph node dissection based on a left modified template is then performed in a completely extraperitoneal manner.
  
  
  RESULTS
  Surgical time was 330 minutes, blood loss was 150 ml. and 58 lymph nodes were removed. Resumption of physical activity and oral intake was achieved on postoperative day 1. Hospital stay was 36 hours. Postoperative narcotic requirement was 28 mg. morphine sulfate equivalent. There were no intraoperative or postoperative complications. Normal antegrade ejaculation returned postoperatively.
  
  
  CONCLUSIONS
  This novel surgical technique is technically feasible and associated with satisfactory clinical outcomes in our preliminary study. Further studies are necessary to evaluate its potential as an alternative to the previously reported transperitoneal and retroperitoneoscopic approaches to laparoscopic retroperitoneal lymph node dissection.
authors.affiliation: Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Thomas  H
authors.initials: T
authors.lastname: Hsu
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Su
authors.forename: Albert
authors.initials: A
authors.lastname: Ong
mesh_terms: D000328:Adult; D018237:Germinoma / Q000556:secondary / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery