title: Robot - assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor.
abstract: OBJECTIVE
  Retroperitoneal lymph node dissection (RPLND) is indicated for patients with non-seminomatous germ cell tumor (NSGCT) with residual disease after chemotherapy. Although the gold standard approach is still the open surgery, few cases of robot-assisted laparoscopic RPLND have been described. Herein, we aim to present the surgical technique for robot-assisted laparoscopic RPLND.
  
  
  METHODS
  A 30 year-old asymptomatic man presented with left testicular swelling for 2 months. Physical examination revealed an enlarged and hard left testis. Alpha-fetoprotein (>1000ng/mL) and beta-HCG (>24.000U/L) were increased. Beta-HCG increased to >112.000U/L in less than one month. The patient underwent a left orchiectomy. Pathological examination showed a mixed NSGCT (50% embryonal carcinoma; 30% teratoma; 10% yolk sac; 10% choriocarcinoma). Computed tomography scan revealed a large tumor mass close to the left renal hilum (10x4x4cm) and others enlarged paracaval and paraortic lymph nodes (T2N3M1S3-stage III). Patient was submitted to 4 cycles of BEP with satisfactory response. Residual mass was suggestive of teratoma. Based on these findings, he was submitted to a robot-assisted RPLND.
  
  
  RESULTS
  RPLND was uneventfully performed. Operative time was 3.5 hours. Blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. Pathological examination showed a pure teratoma. After 6 months of follow-up, patient is asymptomatic with an alpha-fetoprotein of 2.9ng/mL and an undetectable beta-HCG.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic RPLND is a feasible procedure with acceptable morbidity even for post chemotherapy patients when performed by an experienced surgeon.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
authors.forename: Fabio C M
authors.initials: FC
authors.lastname: Torricelli
authors.affiliation: Instituto do Câncer do Estado de São Paulo (ICESP), SP, Brasil.
authors.forename: Denis
authors.initials: D
authors.lastname: Jardim
authors.affiliation: Instituto do Câncer do Estado de São Paulo (ICESP), SP, Brasil.
authors.forename: Giuliano B
authors.initials: GB
authors.lastname: Guglielmetti
authors.affiliation: Global Robotics Institute, Orlando, Florida, EUA.
authors.forename: Vipul
authors.initials: V
authors.lastname: Patel
authors.affiliation: Instituto do Câncer do Estado de São Paulo (ICESP), SP, Brasil.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Coelho
mesh_terms: D000328:Adult; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods*; D013724:Teratoma / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome