Abstract：Objective:To introduce our initial experience of laparoendoscopic single site (LESS) retroperitoneal lymph node dissection (RPLND) for treatment of nonseminomatous testicular cancer.Methods:From September 2010 to May 2012, 5 male patients (age 19-27 years old), present with enlarged right testicle and elevated alpha-fetoprotein (AFP) level, underwent radical orchidectomy. The histopathological analysis revealed nonseminomatous germ cell tumor. Laparoendoscopic single site retroperitoneal lymph node dissection (LESS-RPLND) was performed 3 weeks after orchiectomy. After the 3 cm right pararectus incision was made in right lower quadrant, the homemade port was inserted. Prebent devices, conventional straight laparoscopic equipments, 30 degree lens, harmonic scalpel, bipolar forceps and Hem-o-lok clips were employed. Retroperitoneal space was created and developed with blunt dissection. The unilateral RPLND with nerve-sparing technique was conducted and modified right-sided template was removed in accordance with open RPLND.Results:The operation was successfully performed through the solo pararectus incision and mean operative time was 240 min. Mean estimated blood loss was 50 ml. No conversion to open or conventional laparoscopic surgery was required. No major perioperative complications was observed. For the first case, number of lymph nodes obtained on final histopathological examination was 11 and two positive nodes were detected. For the other 4 cases, no positive nodes were detected. Chemotherapy was needed for the first case. AFP level decreased close to base line one week postoperatively and no relapse was observed 3 month after RPLND.Conclusions:In our experience, LESS-RPLND is safe and feasible, and pararectus incision gains good approach and satisfied cosmetic result. Large population-bases study and long time follow-up were needed to prove the oncological outcome of LESS-RPLND.
[1]Foster R, Bihrle R. Current status of retroperitoneal lymph node dissection and testicular cancer: when to operate. Cancer Control, 2002, 9 ( 4) : 277-283. [2]Williams SB, McDermott DW, Winston D, et al. Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data. BJU Int, 2010,105(7): 918-921. [3]Rassweiler JJ, Scheitlin W, Heidenreich A, et al. Laparoscopic retroperitoneal lymph node dissection: does it still have a role in the management of clinical stage I nonseminomatous testis cancer? A European perspective. Eur Urol, 2008, 54(5):1004-1015. [4]Canes D, Desai MM, Aron M, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol, 2008, 54 (5):1020-1029. [5]Rane A, Rao P, Rao P. Single port access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port). Urology, 2008, 72 (2):260-263. [6]Desai MM, Berger AK, Brandina R, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology, 2009, 74(4):805-812. [7]White WM, Haber GP, Goel RK, et al. Single-port urological surgery: single-center experience with the first 100 cases. Urology, 2009,74(4):801-804. [8]刘春晓, 徐啊白, 陈玢屾, 等. 世界首例单孔腹腔镜根治性膀胱切除、全去带乙状结肠原位新膀胱术. 南方医科大学学报,2010, 30 (6): 1385-1388. [9]徐啊白, 刘春晓, 郑少波, 等. 经脐单孔腹腔镜腹膜外前列腺癌根治术7例报告. 临床泌尿外科杂志, 2011, 26 (3):165-168. [10]温勇,徐啊白,刘春晓,等. 世界首例单孔腹腔镜下男假两性畸形整形术. 南方医科大学学报,2011, 31 (6): 933-936. [11]Vidal-Mora I, Castillo OA. Retroperitoneal laparoscopic lymph node dissection (RPLND) in testicular cancer. Arch Esp Urol, 2010;63(5):373-379. [12]刘春晓, 徐啊白, 郑少波,等. 单孔腹腔镜下根治性膀胱切除术10例报告. 中华泌尿外科杂志, 2011,32(2): 90-93. [13]Tracy CR, Raman JD, Cadeddu JA, et al. Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol, 2008, 5(10):561-568. [14]Kaouk JH, Autorino R, Kim FJ, et al. Laparoendoscopic Single-site Surgery in Urology: Worldwide Multi-institutional Analysis of 1076 Cases. Eur Urol, 2011, 60(5):998-1005.
