Robot-assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor

The treatment of stage I non-seminomatous germ cell (NSGCT) tumor includes retroperitoneal lymph node dissection (RPLND) for patients with high-risk tumor characteristics and for those patients with residual masses after primary chemotherapy. Laparoscopic RPLND (L-RPLND) was initially performed to reduce the morbidity associated with open RPLND (O-RPLND) and at the same time maintain the staging and therapeutic benefits of lymph node removal. However, L-RPLND is a challenging procedure and requires extensive experience with laparoscopic techniques including laparoscopic control of bleeding. Robotic RPLND (R-RPLND) provides enhanced endoscopic visibility, improved dexterity, and superior control of bleeding over L-RPLND. The robotic platform has allowed for a full bilateral RPLND to be performed in one setting without the need to reposition the patient. The bilateral approach as well as improved vascular control has permitted R-RPLND to be expanded to patients with post chemotherapy masses.