Retroperitoneal lymphadenectomy by videolaparoscopic transperitoneal approach in patients with non-seminomatous testicular tumor.
OBJECTIVE
The present study aims to report the preliminary experience with videolaparoscopic retroperitoneal lymphadenectomy in the treatment of patients with non-seminomatous testicular tumor.


METHODS
Seven surgeries were performed in order to access retroperitoneal lymph nodes in patients with non-seminomatous testicular cancer. We performed the videolaparoscopic retroperitoneal lymphadenectomy (LRL) technique in 5 patients with stage I disease and laparoscopic resection of residual mass (LRRM), following chemotherapy (ChT), in 2 patients with stage II disease. Initial approach was obtained through 4 trocars, using an incision in supra-umbilical midline when manual assistance was required. Surgical time was analyzed, as well as blood loss, need for analgesic drugs postoperatively, hospital stay, complications, need for blood transfusion, histopathological data and tumor control in a mean follow-up of 18 months.


RESULTS
Mean surgical time was 200 to 260 minutes in LRL and LRRM groups respectively, mean blood loss was 300 mL for the LRL group and 400 mL for the LRRM group, without need for transfusions. There was a lesion in the vena cava in the LRL group, which was managed with manual assistance and one conversion in the LRRM group, due to a 10-cm tumor mass that was adhered to the aorta. Mean hospital stay was 3 days, excluding the converted case, and the use of analgesic drugs was needed until the second postoperative day. Of the stage I patients, 2 had active disease in retroperitoneum, and underwent adjuvant ChT. The 2 residual masses were teratomas. There was no recurrence during the follow-up period.


CONCLUSIONS
Videolaparoscopic retroperitoneal lymphadenectomy is a procedure with high technical complexity and a higher potential for conversion when performed following chemotherapy.
Tobias-Machado
M
M
Discipline of Urology, ABC Medicine School, Santo André, São Paulo, Brazil. tobias-machado@uol.com.br
Zambon
João P
JP
Ferreira
Alexandre D
AD
Medina
Jimmy A
JA
Juliano
Roberto V
RV
Wroclawski
Eric R
ER
D000328:Adult; D005500:Follow-Up Studies; D018237:Germinoma / Q000556:secondary / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D014741:Video Recording