The current status of laparoscopic retroperitoneal lymph node dissection for non-seminomatous germ-cell tumors.

An appropriately performed retroperitoneal lymph node dissection (RPLND) is both a diagnostic and a therapeutic procedure in the management of non-seminomatous germ-cell tumors. In an attempt to minimize the morbidity associated with an open RPLND, several investigators have evaluated the role of laparoscopic RPLND. Laparoscopic RPLND is technically feasible in the hands of dedicated experts, and results in a reduced hospital stay, operative blood loss, and post-operative morbidity compared to open RPLND. Currently, however, none of the reports in the literature have adequately evaluated the therapeutic efficacy of laparoscopic RPLND, as the vast majority of patients are treated with adjuvant chemotherapy regardless of the risk of systemic relapse. Future prospective internal review board-approved trials need to be developed to evaluate the therapeutic efficacy of laparoscopic RPLND, with careful observation of patients with pathologic low-volume nodal disease.