title: Laparoendoscopic single-site retroperitoneal lymph node dissection in non-seminomatous germ cell malignancy.
abstract: BACKGROUND
  Umbilical laparoendoscopic single-site (LESS) surgery represents an excellent alternative to laparoscopic or robotic multiport surgery. LESS surgery offers faster recovery, less postoperative pain and optimal cosmetic results. LESS is possible in virtually any urologic surgery.
  
  
  METHODS
  We present a 38-year-old male with BMI 31.2 and with history of stage I nonseminomatous mixed germ cell tumor showing interaortocaval lymph node recurrence without elevation of tumor markers. Patient was undergone to right laparoendoscopic single-site retroperitoneal lymph node dissection (LDRP-LESS) by umbilical approach using a single-site multichannel KeyPort (Richard Wolf GmbH, Knittlingen, Germany).
  
  
  RESULTS
  After the placement of the device and triangulation of the clips, we proceeded to operate on posterior parietal peritoneum. The descending colon was mobilized to access the retroperitoneum. Complete retroperitoneal lymph node dissection on the right side from iliac vessels to renal vessels, including the paracaval and interaortocaval space, was performed. The specimen was inserted into a laparoscopic bag and was removed together with multichannel system. Abdominal drainage was not employed. Surgical time was 85 min and estimated bleeding 50 cc. The patient was very satisfied with the cosmetic results and was discharged the following day without needing analgesia. The pathology report revealed metastatic seminoma in 5 of 11 lymph nodes receiving systemic chemotherapy (VP16-CDDPs) for 4 cycles with good tolerance. A year later, the patient was disease-free and had no complications.
  
  
  CONCLUSIONS
  Umbilical primary LDRP-LESS, with excellent oncologic and cosmetic results, is feasible in selected cases. This approach could be considered the least invasive surgical option economically advantageous due to the reusable nature of the instruments used.
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España. Electronic address: javier.angulo@salud.madrid.org.
authors.forename: J C
authors.initials: JC
authors.lastname: Angulo
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Redondo
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
authors.forename: H
authors.initials: H
authors.lastname: Gimbernat
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Ramón de Fata
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: García-Tello
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: García-Mediero
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D014472:Umbilicus
chemical_list: D005047:Etoposide; D002945:Cisplatin
keywords: Cirugía laparoendoscópica por puerto único; Germ cell malignancy; Laparoendoscopic single site surgery; Linfadenectomía retroperitoneal; Retroperitoneal lymph node dissection; Tumor de células germinales