A minimally-invasive RPLND involves the use of small incisions and instruments to perform a RPLND. Johns Hopkins was one of the pioneering institutions in minimally-invasive RPLND, performing over 100 laparoscopic RPLND since 1992. With robotic technology, most minimally-invasive RPLND are performed with robotic assistance as this technology allows better control and more precise dissection around important vascular structures and the nerves that control ejaculation.
Most minimally-invasive RPLND are performed in men with clinical stage I non-seminomatous germ cell tumors. These men do not have any visible, enlarged lymph nodes. For these men, a unilateral (or one-sided) template dissection can be performed. The lymphatic drainage in the body goes from right to left. Therefore men with a left-sided testicular tumor can undergo a left-sided modified template that involves dissection of lymphatic tissue on and around the aorta. For men with right-sided testicular tumors, the lymphatic tissue from around the vena cava to the aorta needs to be removed.
For men with clinical stage II NSGCT tumors, a minimally-invasive RPLND can be performed. However, it is recommended that any patient with enlarged lymph nodes undergo a complete, bilateral (both-sides) RPLND.
There are many theoretical and real advantages to undergoing minimally-invasive RPLND:
- Avoidance of chemotherapy: the long-term side-effects of chemotherapy is not known for young men with a long life expectancy. Possible side-effects include:
- Early cardiovascular disease
- Increased rate of secondary malignancies (leukemia and lymphoma most common)
- Shorter hospital stay and recovery: most patients leave the hospital the day after surgery
- Avoidance of a post-chemotherapy RPLND: complication rates after post-chemotherapy RPLND are higher, hospital stay and recovery time are also longer.
- Low rates of anejaculation: the rates of anejaculation after unilateral, template RPLND are 5% or less