Introduction & Objectives:
Robotic RPLND (R-RPLND) has been shown to be a viable alternative to open RPLND with lower perioperative morbidities, while maintaining the same oncological outcomes. Herein, we report our initial experience with R-RPLND at a single tertiary referral centre.
Methods:
Retrospective review of our prospectively collected database was performed of all patient undergoing R-RPLND at our institution from May 2018 till September 2019. Demographic data, operative parameters, oncological and perioperative outcomes were examined. Intraoperative as well as 30 & 90 day post-operative complications were recorded using Clavien-Dindo classifications.
Results:
Overall, 11 patients underwent R-RPLND during the study period. Primary pathology was NSGCT in 9 (82%), Seminoma and paratesticular embryonal rhabdomyosarcoma in 1 (9%)each. 9 (82%) of patients underwent prior chemotherapy with BEP and other 2 patients underwent primary RPLND. Preoperative staging was as following: IIA 2 (18%), IIB 5 (45%), IIC 4(36%) . Nine (82%) patients underwent modified unilateral template resection and two (18%)underwent bilateral template resection.
Median age was 31 (14-39) and Median nodal count was 38 (28-65). Median operative time was 300 min (240-360) and Mean estimated blood loss was 100mls (30-1500) with no cases of blood transfusion. One patient required conversion to open surgery due to difficulty in resection and bleeding from IMA. Pathology results indicated teratoma in 5 (45%); necrosis in 4 (36%), Choriocarcinoma in 1 and embryonal rhabdomyosarcoma in 1.
Median return of bowel function was 1 day(1-2) and mean length of stay was 2 days(2-4). There were no early or late (30 & 90 day) post-operative complications. With median follow up of 9 months (1-18), there were no recurrences.
Conclusions:
R-RPLND is technically a challenging procedure requiring advanced skills, however it is safe and feasible in selected patients and in a dedicated tertiary centres. The robotic approach offers promising early result with lower perioperative morbidity and length of stay. Larger cohorts and longer follow up is required to demonstrate safety and oncological equivalence to open RPLND.