Robot-assisted retroperitoneal lymph node dissection for stage IIA–IIB testicular germ cell tumor

Background. For a long time, open retroperitoneal lymph node dissection remained the gold standard for the treatment of testicular germ cell tumors. A minimally invasive approach using endoscopic technologies made it possible to solve a number of problems reducing surgical risks for the patient and the perioperative burden for the operating team. Due to the widespread use of robotic surgery in urology, robot-assisted retroperitoneal lymph node dissection (RA-RPLND) has been gaining popularity since its introduction. However, in Russian practice, there are still no published data regarding the discussed technique.

Materials and methods. At the N.N. Petrov National Medical Research Center of Oncology, a total of 70 RA-RPLND were performed between June 2022 and May 2025. The requirements for RA-RPLND were: testicular germ cell tumors IA–IIA; residual tumor of the retroperitoneal space before the start of systemic chemotherapy < 4 cm in diameter or visualized retroperitoneal lymph nodes up to 2 cm in patients who did not undergo polychemotherapy; normal levels of serum tumor markers (α-fetoprotein, β-human chorionic gonadotropin, lactate dehydrogenase). The operations were performed using the da Vinci Xi robot-assisted surgical system. All patients were treated according to the early rehabilitation program using the ERAS system (Enhanced Recovery After Surgery). Lymph nodes, testicular germ cell tumors risk factors, intra- and postoperative parameters were evaluated. Functional results were also assessed.

Results. Mean number of lymph nodes was 30 ± 12. Mean operative time was 209 ± 62 minutes, median intraoperative blood loss was 100 mL, and mean hospital stay was 9 ± 3 days. No perioperative transfusion was required. There were 16 early and no late complications in the postoperative period. Histological examination revealed the following: necrosis in 25 (35.7 %) patients, fibrosis in 3 (4.3 %) patients, mature teratoma in 4 (5.7 %) patients, and viable tumor in 4 (5.7 %) patients. The median postoperative follow-up was 14.8 months. Antegrade ejaculation was achieved in 32.9 % of patients after RA-RPLND. In one patient, ejaculatory status could not be assessed due to erectile dysfunction. Retrograde ejaculation was observed in 47 (67.1 %) patients.

Conclusion. RA-RPLND has significant advantages over traditional approaches, including being less invasive, shorter recovery time, and reduced risk of complications. It is necessary to study the long-term results of RA-RPLND in terms of patient survival and quality of life, as well as to develop new technologies aimed at increasing the efficacy and availability of this method.