title: Laparoscopic retroperitoneal lymph node dissection in the extremely obese patient: technical insight into access and port placement.
abstract: OBJECTIVE
  We report on laparoscopic retroperitoneal lymph node dissection (RPLND) in a morbidly obese patient to discuss the associated technical steps for satisfactory completion of staging lymphadenectomy.
  
  
  METHODS
  A laparoscopic RPLND was performed using a modified template on the left side. Initially, 4 ports were placed with the patient in the supine position. Three were placed 3 cm to the left of midline and one in the anterior axillary line, at the level of the umbilicus. During the operation, successful bowel retraction necessitated placement of 2 additional ports in the anterior axillary line (just above the pelvis and off the tip of the 12th rib). Using these 6 trocar sites, the dissection was completed, and 44 lymph nodes were obtained.
  
  
  RESULTS
  Laparoscopic retroperitoneal lymph node dissection was accomplished in an extremely obese patient with acceptable morbidity by using prudent modification of standard techniques.
  
  
  CONCLUSIONS
  If access and port placement limitations are overcome, the benefits of laparoscopy in the obese are clear. This report serves as a signpost that laparoscopic retroperitoneal lymph node dissection for testes cancer can also be accomplished using modification of standard techniques.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Sherwood
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Koeneman
mesh_terms: D000328:Adult; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid; D018239:Seminoma / Q000473:pathology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery