Robot-Assisted Transmesocolic Retroperitoneal Lymphadenectomy in Testicular Non-Seminomatous Germ Cell Tumors: A Promising Approach.

Abstract

Introduction: Testicular cancer accounts for 5% of urological tumors, with an incidence of 5.6 cases per 100,000 men per year in Europe (1). Salvage retroperitoneal lymphadenectomy is the standard surgery for persistent retroperitoneal masses after chemotherapy. The advent of minimally invasive surgery is changing the therapeutic approach. The objective is to present our initial experience with the transmesocolic robotic approach for the surgical management of these masses.

Methods: We report the perioperative and oncological outcomes of four patients affected by non-seminomatous germ cell tumors who were treated with transmesocolic robotic left para-aortic retroperitoneal lymphadenectomy.

Results: The surgical time for the first case was 220 minutes, and the average surgical time for the remaining cases was 120 minutes (SD: 15). Estimated blood loss was 82.5 ml (SD: 79.3). No intraoperative or postoperative complications were observed. Pathological anatomy revealed post-pubertal teratoma (30%) and necrosis (70%) in case 1, necrosis with reactive adenitis in case 2, extensive fibrosis in case 3 and post-pubertal teratoma in case 4. Currently, all patients are disease-free.

Conclusions: Robotic retroperitoneal lymphadenectomy is a safe and precise technique that offers favorable oncological and functional outcomes. The transmesocolic approach represents a feasible option in selected cases, ensuring rapid retroperitoneal access and reduced surgical time.