title: Midline extraperitoneal approach for retroperitoneal lymph node dissection for testicular germ cell tumor.
abstract: BACKGROUND
  Retroperitoneal lymph node dissection (RPLND) for the treatment of testicular germ cell tumor is technically difficult and associated with significant morbidity. We postulated that a novel midline extraperitoneal (EP) approach might minimize the morbidity.
  
  
  METHODS
  We describe a midline extraperitoneal approach in detail. The operative time, estimated blood loss, lymph node yield, return of bowel function, length of stay, and postoperative complications were retrospectively reviewed. From April 2010 to May 2011, 12 consecutive patients underwent EP-RPLND at 2 tertiary centers by a single surgeon, including 5 primary and 7 postchemotherapy RPLNDs. The clinical characteristics and outcomes were compared with those from a matched cohort of transperitoneal-RPLND patients.
  
  
  RESULTS
  The median follow-up was 173 and 201 days in the EP and transperitoneal groups, respectively. The EP group had a shorter mean operative time of 292 versus 337 minutes (P = .02) and lower estimated blood loss of 305 versus 575 mL (P = .05). More lymph nodes were retrieved in the EP group (44 vs 27 nodes, P = .0006). Finally, an earlier return of bowel function (1.7 vs 2.9 days, P = .0001) and a shorter median length of stay (3.3 vs 5.3 days, P = .0001) was seen in the EP group.
  
  
  CONCLUSIONS
  EP-RPLND can be performed safely without prolonged operative times or compromised lymph node retrieval, even in the postchemotherapy setting, and is associated with a faster return of bowel function and shortened length of stay.
authors.affiliation: University of Southern California Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033-9178, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Kim
authors.forename: Sumeet
authors.initials: S
authors.lastname: Syan-Bhanvadia
authors.forename: Hooman
authors.initials: H
authors.lastname: Djaladat
authors.forename: Ken
authors.initials: K
authors.lastname: Faber
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Tadros
authors.forename: Craig
authors.initials: C
authors.lastname: Nichols
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001810:Blood Volume; D003672:Defecation; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary* / Q000601:surgery; D061646:Operative Time; D020127:Recovery of Function; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult