title: Robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in the adolescent population.
abstract: BACKGROUND
  Robot-assisted retroperitoneal lymph node dissection (RA-RPLND) has built on success and techniques of laparoscopic RPLND, with the added benefits of robotic technology. This paper demonstrates use of the da Vinci Xi®system for RA-RPLND in two adolescent patients.
  
  
  METHODS
  Case #1: A 17-year-old male presented with a left testicular mass and elevated alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Pathology revealed a mixed non-seminomatous germ cell tumor (60% embryonal, 35% yolk sac, 5% choriocarcinoma, + lymphovascular invasion). Tumor marker normalized post-orchiectomy, and staging imaging was without evidence of metastatic disease. After discussion of options he opted to undergo RA-RPLND. Case #2: A 15-year-old male presented with a right para-testicular mass and negative tumor markers. He underwent inguinal exploration and excision of the paratesticular mass. Final pathology revealed an ectomesenchymoma with a spindle cell rhabdomyosarcoma component. Staging imaging was negative, and after discussion of options he underwent completion orchiectomy and RA-RPLND.
  
  
  RESULTS
  The patient in Case #1 underwent a left modified-template nerve-sparing RA-RPLND. Sixteen lymph nodes were negative for tumor. The patient in Case #2 underwent complete bilateral nerve-sparing RA-RPLND. Forty-two lymph nodes were negative for tumor. Estimated blood loss was <50 cc for both cases, and console time averaged 262 min.
  
  
  CONCLUSIONS
  This was a report of two cases of RA-RPLND in the adolescent population. RA-RPLND is technically feasible in this population, and further study of RA-RPLND is needed to determine long-term outcomes, as this technique is becoming more widely adopted.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Glaser
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Bowen
authors.affiliation: Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Lindgren
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: joshua.meeks@northwestern.edu.
authors.forename: J J
authors.initials: JJ
authors.lastname: Meeks
mesh_terms: D000293:Adolescent; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D009919:Orchiectomy / Q000379:methods*; D011379:Prognosis; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery; D012208:Rhabdomyosarcoma / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D012494:Sampling Studies; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: Lymph node excision; Pediatrics; Robotics; Testicular neoplasms; Urological surgical procedures