The Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA.
J Robot Surg. 2023 Dec;17(6):3045-3048. doi: 10.1007/s11701-023-01735-3. Epub 2023 Nov 16.
Robotic assisted (RA) retroperitoneal lymph node dissection (RPLND) has grown in popularity as it offers decreased morbidity and faster recovery compared to the open technique. Proponents of open surgery raised concerns about the oncological fidelity of the RA approach for testicular tumors where complete resection is needed. In boys > 10 years with paratesticular rhabdomyosarcoma (RMS), RPLND is indicated for staging purposes only. In this population, the RA technique should provide its benefits without concerns for oncological compromise. We present an analysis of RA-RPLND for boys with paratesticular RMS. We queried our institution's prospectively collected database of pediatric robotic cases for patients undergoing RA-RPLND post-radical orchiectomy for paratesticular mass, confirmed by pathology as RMS. Demographic, surgical, follow-up, and oncological outcomes were evaluated between 2017 and 2023. Five patients underwent RA-RPLND for paratesticular RMS. The median age was 16.1 years (15-17), with median OR time of 456 min (357-508). No conversions to open occurred. Inpatient median total opioid use was 1.8 (0.4-2.7) morphine equivalent/kg. The median lymph node yield was 27 (8-44) and post-op length of stay was 3 days (2-5). The median time to initiating adjuvant chemotherapy was 10.5 days (7-13). One patient had complications: pneumothorax attributed to central line placement and chyle leak that resolved in 1 week with dietary restriction. Our series demonstrates the feasibility, safety, and efficacy of the RA approach for RPLND in pediatric patients with paratesticular RMS. This is the most extensive case series currently in the literature and the only one exclusively done for paratesticular RMS.
机器人辅助（RA）腹膜后淋巴结清扫术（RPLND）因其与开放技术相比具有降低发病率和更快恢复的优势而越来越受欢迎。开放手术的支持者对 RA 方法在需要完全切除的睾丸肿瘤中的肿瘤学准确性表示担忧。对于> 10 岁的儿童伴腹膜后横纹肌肉瘤（RMS），RPLND 仅用于分期目的。在这种情况下，RA 技术应该可以提供其益处，而不会对肿瘤学造成影响。我们对接受机器人辅助根治性睾丸切除术治疗腹膜后 RMS 的男孩进行了 RA-RPLND 分析。我们查询了我们机构前瞻性收集的儿科机器人病例数据库，以获取经病理证实为 RMS 的腹膜后肿块接受 RA-RPLND 治疗的患者。评估了 2017 年至 2023 年期间的人口统计学、手术、随访和肿瘤学结果。5 例患者因腹膜后 RMS 接受 RA-RPLND。中位年龄为 16.1 岁（15-17），中位手术时间为 456 分钟（357-508）。无中转开放手术。住院患者中位数总阿片类药物使用量为 1.8（0.4-2.7）吗啡当量/公斤。中位淋巴结收获量为 27（8-44），术后住院时间为 3 天（2-5）。开始辅助化疗的中位时间为 10.5 天（7-13）。1 例患者发生并发症：气胸归因于中心静脉置管和乳糜漏，通过限制饮食在 1 周内得到解决。我们的系列研究表明，RA 方法在儿科腹膜后 RMS 患者中进行 RPLND 是可行、安全和有效的。这是目前文献中最大的病例系列，也是唯一一个专门针对腹膜后 RMS 的病例系列。
