Single-Position Intraperitoneal Laparoscopic Retroperitoneal Lymph Node Dissection and Pelvic Lymph Node Dissection for Testicular Cancer in Modified Supine Position

Abstract

Introduction:

The management of testicular cancer with pelvic lymph node involvement or recurrence presents a clinical challenge. While current consensus favors chemotherapy as the first-line treatment, surgical resection of metastatic lesions and lymph node dissection remain crucial for residual disease. ¹ Specifically, the indication for concurrent pelvic lymph node dissection (PLND) during post-chemotherapy retroperitoneal lymph node dissection for such patients lacks a definitive consensus. However, a large single-center study suggests that concurrent PLND should be considered for those with documented pelvic disease. ² Performing both RPLND and PLND laparoscopically is technically demanding due to the extensive surgical field. There is a paucity of literature detailing a streamlined laparoscopic technique for this combined procedure. This video article aims to describe a novel single-position intraperitoneal laparoscopic (SP-ILS) technique for concurrent RPLND and PLND.

Materials and Methods:

In this video, we detailed the technical steps. Building on our established and published experience with the SP-ILS technique for radical nephroureterectomy,^3,4 we adapted it for testicular cancer. We retrospectively reviewed four patients with testicular germ cell tumors and either suspected pelvic metastasis or pelvic recurrence who underwent SP-ILS RPLND and PLND at our institution from 2022 to 2026. All four patients had received four cycles of cisplatin, etoposide, and ifosfamide chemotherapy preoperatively, yet residual pelvic lesions persisted.

Results:

This approach offers two key advantages: (1) enhanced operative field exposure for both procedures and (2) elimination of repositioning or re-docking requirements, thereby streamlining workflow. All four cases were completed laparoscopically without conversion to open surgery. The mean operative time was 173 ± 44 min, and the mean estimated blood loss was 145 ± 43 mL. The mean lymph node yield was 18 for the RPLND field and 12 for the PLND field. No intraoperative complications occurred. Final pathology of the resected specimens revealed mixed nonseminomatous germ cell tumors in three patients and mixed seminoma in one patient. At a mean follow-up of 18 months, all patients are alive with no recurrence and postoperative complications.

Conclusions:

The SP-ILS technique represents a feasible and efficient minimally invasive strategy for performing concurrent RPLND and PLND in testicular cancer patients with pelvic disease. It addresses the technical challenge of the extensive surgical field by eliminating intraoperative repositioning, potentially reducing operative time. Our initial experience, as detailed in this video article, demonstrates its practicality. Larger studies and longer follow-up are warranted to further validate its efficacy and safety.

Acknowledgments:

The authors sincerely thank the dedicated nursing and anesthesia teams for their exceptional skill, invaluable assistance, and unwavering support throughout the perioperative period.

Patient consent statement:

The authors confirm they have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

The authors have no relevant conflicts of interest to declare.

No funding was received for this article.

Runtime of video: 5 min 45 sec.