Category: Robotic Surgery: New Techniques - Malignant

Introduction & Objective :

In this video we describe a robotic retroperitoneal limphadenectomy for NSGCT residual disease after chemotherapy

Methods :

We present a case of a 18-yr old male, who underwent right orchiectomy for non seminomatous germ cell tumor. After 4 cycles of adjuvant chemotherapy the CT Scan showed a 3 cm retroperitoneal residual mass, anteriorly to the inferior vena cava , close to the aortic bifurcation.
The patient was placed in a supine position and a right template limphnode dissection was planned, including complete removal of the ipsilateral spermatic cord.After a steep Trendelemburg position, the Robot was docked behind the patient's shoulders. Using the da Vinci Si, the ports were positioned like Stepanian et al described. The posterior peritoneum was incised medially to the cecum, extending the incision along the ligament of Treitz. A barbed suture was then passed through the posterior peritoneum, and then passed back through the anterior abdominal wall. This is performed on both sides of the cut of the posterior peritoneum, elevating the small bowel and exposing the retroperitoneal space. The anterior aspect of inferior vena cava and aorta is visualised, and the nodal mass is clearly identified, as previously highlighted in the CT scan. Interaortocaval limphnode dissection is progressively performed, dissecting the limphatic tissue proximal to the nodal mass and isolating its cranial aspect. The residual mass was approached, starting from the aortic aspect, with a shurp and blunt meticolous dissection. The distal aspect of the mass was identified and isolated, with a progressive dissection through the anterior wall of inferior vena cava. The specimen was removed and secured into an endocatch bag. Interaortocaval limphnode dissection was completed.Paracaval limphadenectomy was performed, with the right eureter as lateral boundary.
The right template limphnode dissection was completed.
Right spermatic cord was dissected and removed without any robot redocking.
The operatory field was irrigated with fibrin glue to reduce limphatic leakage.

Results :

Perioperative course was uneventful. The patient was discharged in postoperative day 5. The pathologic report confirmed the metastatic non seminomatous nature of the mass.

Conclusions :

Robotic retroperitoneal limphadenectomy for NSGCT residual disease is a safe and feasible treatment option in tertiary referral centers.

Presenting Author(s)

• 

  Gabriele Tuderti

  – Fellow, "Regina Elena" National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy

Author(s)

• 

  Giuseppe Simone

  – Consultant, “Regina Elena” National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy
• LM

  Leonardo Misuraca

  – Fellow, "Regina Elena" National Cancer Institute, Dept. of Urology, Rome, Lazio, Italy
• MF

  Mariaconsiglia Ferriero

  – MD, PhD, "Regina Elena" National Cancer Institute, Dept. of Urology, Rome, Lazio, Italy
• FM

  Francesco Minisola

  – "Regina Elena" National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy
• SG

  Salvatore Guaglianone

  – "Regina Elena" National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy
• 

  Michele Gallucci

  – Roma, Lazio, Italy