Testicular Cancer

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Minimally-invasive RPLND

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.  
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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 

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