Robot assisted retroperitoneal lymph-node dissection after adjuvant therapy: different indications.
BACKGROUND
Today, access to technology through robotic surgery has allowed urologists to have a valuable tool in order to perform various robot -assisted laparoscopic procedures. Robotic surgery allows reproducing complex techniques such as retroperitoneal or extended pelvic lymphadenectomy. The aim of the study was to report our series of robot assisted retroperitoneal lymphadenectomy and to demonstrate its technical and oncological feasibility.


METHODS
A retrospective analysis on 7 patients (four cases of testicular tumors, one prostate adenocarcinoma, and two bladder urothelial carcinomas), who underwent retroperitoneal para-aortic, interaorto-cava and extended pelvic lymphadenectomy by robot assisted laparoscopic surgery, was conducted. We analyzed demographic, oncologic and operative data (surgical time, blood loss, and hospital stay).


RESULTS
Demographic and operative data showed a mean age of 49 years (18-65), mean BMI of 26.1 kg/m2(23.7-29.1), mean operative time of198 minutes (180-220), mean estimated blood loss of 88 mL, and mean hospital stay of 3.6 days (3-5). No intraoperative complications occurred. Themean number of dissected nodes was 12 (3-20). Histopathology findings showed one case of postchemotherapy recurrenceof seminoma and six cases of fibrosis. At a mean postoperative follow-up of 39 months (7-75) no patients showed disease recurrence.


CONCLUSIONS
Our case series demonstrated that the robot assisted approach isa feasible and reproducible option in skilled robotic surgical referral centers. The surgeons' experience and the optical magnification, associated to the degree of freedom offered by robotic assisted laparoscopy allow achievinga precise lymph node dissection, also in advanced oncologic patients.
Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.|Department of Uro-Oncology, Faculty of Medicine, National University of México (UNAM), General Hospital of México, Mexico City, Mexico.
Victor E
VE
Corona Montes
Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain - antopast@hotmail.com.|Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy.
Antonio L
AL
Pastore
Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
Louis
L
Gausa
Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
Oscar
O
Rodríguez-Faba
Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
Alberto
A
Breda
Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
Joan
J
Palou
D000293:Adolescent; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000601:surgery; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000601:surgery; D014565:Urogenital Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D055815:Young Adult