title: Extraperitoneal laparoscopic retroperitoneal lymph node dissection for early-stage testicular nonseminomatous germ cell tumors: initial experience.
abstract: OBJECTIVE
  To investigate a modified laparoscopic retroperitoneal lymph node dissection technique using an extraperitoneal approach and to evaluate its feasibility.
  
  
  METHODS
  A group of consecutive patients from a single institution underwent extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RLND) at weeks after orchiectomy for primary testicular nonseminomatous germ cell tumors (NSGCT). All patients were placed in the supine position and tilted up 15 degrees on the affected side. Four trocars were introduced. The templates of lymph node dissection conformed to those of Weissbach and Boedefeld.
  
  
  RESULTS
  EL-RLND was successfully performed in 15 patients (left, 6 patients; right, 9 patients). The mean total operative time for the entire series was 164 ± 49 minutes. The mean blood loss was 118 ± 74 mL. One intraoperative complication was injury of the vena cava, which occurred in one patient. Ureteral obstruction occurred in another patient. The mean postoperative intestinal function recovery time was 2 days. The mean postoperative hospitalization was 5.5 ± 1.1 days. Normal antegrade ejaculation was preserved in all patients. Pathologic studies revealed positive lymph nodes in three (20%) patients. No recurrence or distant metastasis occurred during 2 to 32 months of follow-up.
  
  
  CONCLUSIONS
  EL-RLND is a safe and feasible procedure using an improved extraperitoneal approach that provides minimal invasion and rapid recovery of patients.
authors.affiliation: Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Qin
authors.forename: Pengfei
authors.initials: P
authors.lastname: Shao
authors.forename: Xiaoxin
authors.initials: X
authors.lastname: Meng
authors.forename: Pu
authors.initials: P
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cao
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lv
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Ju
authors.forename: Meilin
authors.initials: M
authors.lastname: Wang
authors.forename: Zhengdong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Min
authors.initials: M
authors.lastname: Gu
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Changjun
authors.initials: C
authors.lastname: Yin
mesh_terms: D000328:Adult; D003710:Demography; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000601:surgery*; D056888:Patient Positioning; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D012187:Retroperitoneal Space / Q000601:surgery*; D013525:Surgical Instruments; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult