Robotic retroperitoneal lymph node dissection for post-chemotherapy nodal mass in testicular non-seminomatous germ cell tumours: Initial experience, insights into patient selection and point of technique.

Abstract

Introduction: To evaluate the outcomes of robotic retroperitoneal lymph node dissection (R-RPLND) for post-chemotherapy residual retroperitoneal masses in patients with testicular non-seminomatous germ cell tumours. Open retroperitoneal lymph node dissection (O-RPLND) is associated with long skin incisions, increased post-operative pain and prolonged recovery. R-RPLND is a minimally invasive alternative, offering improved visualisation and precision, particularly in proximity to major vessels.

Patients and methods: A retrospective analysis of patients who underwent R-RPLND at our centre between January 2023 and January 2026 was conducted. Patient selection was based on imaging and technical feasibility following informed consent. Procedures were performed by a high-volume robotic surgeon using the da Vinci Xi system. Demographic, perioperative and pathological outcomes were evaluated.

Results: Ten patients underwent R-RPLND during the study period. The median age was 27 years. Embryonal carcinoma was the predominant histology on orchiectomy (70%). Sixty percent of patients had clinical N3 disease. Post-chemotherapy serum tumour markers normalised in all but two patients who required second-line chemotherapy. The mean residual nodal mass size was 4 ± 1.58 cm. The median console time and estimated blood loss were 240 min (interquartile range [IQR]: 240-310) and 220 ml (IQR: 90-300), respectively. Three patients required open conversion. Histopathology revealed necrosis in 40%, teratoma in 40% and viable tumour in 20% of the cases. There were no recurrences at a median follow-up of 20 months.

Conclusion: R-RPLND is a safe and feasible alternative to O-RPLND in carefully selected patients. Optimal outcomes depend on meticulous pre-operative planning, patient selection and surgical expertise.