title: Hand-assisted laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular cancer.
abstract: OBJECTIVE
  We describe our initial experience with hand-assisted laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular cancer.
  
  
  METHODS
  Between April 2002 and December 2004, 10 patients with testicular tumor were operated on, 6 on the right side and 4 on the left side. Eight patients were in clinical stage I, one patient was in clinical stage IIA, and one patient was in clinical stage IIB disease. Depending on the tumor site, a 6-7 cm mid-lower or -upper laparotomy was done, the HandPort (Smith and Nephew, Andover, MA) was placed in the abdominal wall, and the left hand of the surgeon was inserted into the abdomen. Four laparoscopic ports were also inserted. The ascending or descending colon was mobilized completely. The retroperitoneal lymph nodes were dissected and removed according to the modification of Weissbach and colleagues.
  
  
  RESULTS
  The average operative time was 258 min (range, 150-432 min). One patient required re-operation because of postoperative bleeding. The average postoperative hospital stay was 3.5 (range, 3-10) days. Patients with stage IIA or IIB disease on histopathology received 2-3 courses of combined chemotherapy. Antegrade ejaculation was preserved in all patients. During follow-up that ranged from 9 to 36 months, there was no local recurrence or distant metastasis.
  
  
  CONCLUSIONS
  Hand assistance makes the laparoscopic operation simpler, faster, and safer. A 6-7 cm muscle-splitting incision should be advantageous for patients compared to the xyphopubic laparotomy of the open procedure. To our knowledge this is the first report on hand-assisted laparoscopic retroperitoneal lymph node dissection.
authors.affiliation: Department of Urology, Semmelweis Hospital, Kiskunhalas, Hungary.
authors.forename: Endre
authors.initials: E
authors.lastname: Holman
authors.forename: Gábor
authors.initials: G
authors.lastname: Kovács
authors.forename: Tibor
authors.initials: T
authors.lastname: Flaskó
authors.forename: Csaba
authors.initials: C
authors.lastname: Maróti
authors.forename: János
authors.initials: J
authors.lastname: Vancsora
authors.forename: Csaba
authors.initials: C
authors.lastname: Tóth
authors.forename: Morshed A
authors.initials: MA
authors.lastname: Salah
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*