title: Laparoscopic retroperitoneal lymphadenectomy for stage I non-seminomatous testicular tumors.
abstract: Retroperitoneal lymph node dissection (RPLND) is the most accurate method to evaluate the presence and extent of retroperitoneal nodal metastases in clinical stage I non-seminomatous germ cell testicular carcinoma. In our Department the open "nerve sparing" RPLND is already the standard surgical treatment for these tumors and laparoscopic technique is employed in surgical treatment of digestive diseases as cholelithiasis, hiatal hernias and gastrointestinal tumors; we report our first experience with laparoscopic RPLND in patients with low stage non-seminomatous germ cell testicular tumors (NSGCTT). A laparoscopic modified template RPLND was performed in 5 high-risk patients with non-seminomatous germ cell clinical stage I tumors by a transperitoneal approach. In 4 of the 5 cases a template dissection was performed. In one pathological stage II tumor a limited lymph node dissection was performed and the patient underwent postoperative chemotherapy. Mean operative time was 190 minutes (range 160-210). No retrograde ejaculation occurred. The mean number of dissected nodes was 21 (range 16-25). At mean follow-up of 16.3 months (range 12-21) the 4 operated patients with pathological stage I NSGCTT are disease free without ejaculatory or urinary dysfunction. Our preliminary experience suggests that laparoscopic RPLND for stage I NSGCTT is feasible and safe for surgeons largely trained in either laparoscopic digestive surgery or open RPLND for whom the learning curve of that minimally invasive approach is lower than expected.
authors.affiliation: Department of Surgical Sciences, La Sapienza University, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Custureri
authors.forename: Paolo
authors.initials: P
authors.lastname: Urciuoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Iavarone
authors.forename: Valerio
authors.initials: V
authors.lastname: D'Orazi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gabatel
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ghinassi
authors.forename: Gregorio
authors.initials: G
authors.lastname: Patrizi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Palazzini
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Di Matteo
authors.forename: Nadia
authors.initials: N
authors.lastname: Peparini
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D018237:Germinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012187:Retroperitoneal Space; D018570:Risk Assessment; D012494:Sampling Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome