Category: Robotic Surgery: New Techniques - Malignant

VS15-7 - Laparoscopic (Robot-assisted) Retroperitoneal Lymph node dissection in NSGCT: Video Demonstration & Single centre experience

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Laparoscopic RPLND (L-RPLND) in non-seminomatous germ cell tumors (NSGCTs) have several limitations. The robotic approach is being attempted to overcome these limitations. We aim to evaluate the surgical technique and outcomes of the robot-assisted retroperitoneal lymph node dissection (R-RPLND) for non-seminomatous germ cell tumors (NSGCT) at our institution.

Methods :

11 patients (2012-2017) underwent R-RPLND for NSGCT [Clinical Stage (CS) I-IIA and Post-chemotherapy residual masses]. Retrospective data on patient demographics, preoperative tumor characteristics, perioperative outcomes [open conversion rate, lymph node (LN) yield, rate of positive LNs, operative time, estimated blood loss (EBL), length of stay (LOS)] & tumor recurrence rates were recorded.

Steps of R-RPLND include caecal mobilization upto ligament of treitz, full bilateral template dissection redocking & excision of the ipsilateral spermatic cord remnant

Results :

The mean operative time was 190 mins, EBL was 103 mL, and LOS was 2.4 days. Teratoma was the commonest pathology with mean LN yield of 22. At a mean follow-up of 15 (6–24) months, there were no recurrences. There were no intraoperative complications, 2 early postoperative complications (18%), no late complications. One patient (9%) with positive nodes received adjuvant chemotherapy. The 2-yr recurrence-free survival rate was 97% (95% CI: 82-100%).

Conclusions :

Robotic surgery is a safe and feasible method for resecting masses especially in areas difficult to reach via open or maneuver laparoscopically. Robotic approach with its 3D - Imaging system improves maneuverability & precision of the dissection in the retroperitoneum and cul-de-sac.


Yuvaraja Tb

Head of robotic surgery and urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Srivathsan Ramani

Fellow - Robotic Urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Santosh SUBHASH. Waigankar

Post Doctoral Fellow in Urooncology and Robotic Surgery
Kokilaben Dhirubhai Ambani Hospital
Mumbai, Maharashtra, India

Dr. Santosh Waigankar is a trained urologist from India who is presently pursuing urooncology and robotic surgery. After completing his training in urology, he decided to venture into subspecialty of urooncology and robotic surgery. He was selected as the first Vattikuti fellow in robotic urooncology in India (2015) and joined Kokilaben Dhirubhai Ambani hospital under the mentorship of Dr. T. B. Yuvaraja. He has been since associated with the department gaining valuable experience in Si and Xi DaVinci setups, as a beside and a console surgeon.

Fueled with curiosity and eagerness to learn he loves to interact with like-minded people across India and all over the world. He believes that gaining professional experience globally helps oneself to improve one’s perspective and broaden one’s approach to managing urological cancers.

He loves research and wants to work in areas as well looking into “unconventional” issues related to urological cancers as a whole e.g. molecular biology and ways to augment treatment outcomes in future. Doing research is his way of reciprocating back to the community.

His first international entry at the European Robotic Urology Society (ERUS 2017) won him the second prize for the best poster submission. The paper analyzed the “measured” outcomes post robotic partial nephrectomies. He has been awarded the scholarship for attending the 38th Société Internationale d'Urologie Congress (SIU 2018), scheduled to be held in Seoul.

He has keen interest in single port robotic surgery and aspires to get trained in the same.

He loves making friends from all walks of life and believes in knowledge sharing to enrich oneself. He is active on social media. He loves blogging and photography and follows cricket, tennis and F1 racing. Balancing between family, friends and professional life has been his priority always.