Janetschek G, Reissigl A, Peschel R, Hobisch A, Bartsch G
Department of Urology, University of Innsbruck, Austria.
Ann Urol (Paris). 1995;29(2):81-90.
Retroperitoneal lymph node dissection for nonseminomatous testicular tumor. A modified retroperitoneal lymph node dissection for stage I testicular tumor has been described by Weissbach. We have developed a two-step procedure for performing laparoscopic retroperitoneal lymph-adenectomy within these boundaries. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised, and the borders of the dissection are defined. Removal of retroaortic and retrocaval nodal tissue is technically not feasible via the ventral approach. Therefore, in the second step, a lateral approach is employed, which is the key to success since it permits easy transection of the lumbar vessels. Thus complete lymph node dissection can be achieved. Between August 1992 and March 1994 this procedure was performed in 15 patients. In nine patients, the tumor was on the right side and in six on the left. Conversion to open surgery was necessary in two patients because of uncontrollable bleeding and a large metastasis, respectively. Microscopic metastases were detected in two other patients. Apart from the above-mentioned bleeding no major complications occurred; no blood transfusion were required. The results obtained so far demonstrate that this procedure is technically feasible. Therefore, we have decided to perform laparoscopic retroperitoneal lymphadenectomy also in patients with stage II B tumors who have received chemotherapy; to date one patient with a left-sided stage II B tumor has been operated on successfully.
非精原细胞瘤性睾丸肿瘤的腹膜后淋巴结清扫术。Weissbach描述了一种用于I期睾丸肿瘤的改良腹膜后淋巴结清扫术。我们在此范围内开发了一种两步法进行腹腔镜腹膜后淋巴结切除术。第一步，采用前路入路。游离结肠，然后切除精索静脉，并确定清扫边界。经前路入路在技术上无法切除主动脉后和腔静脉后淋巴结组织。因此，在第二步中，采用侧路入路，这是成功的关键，因为它便于切断腰血管。从而可以实现完整的淋巴结清扫。1992年8月至1994年3月，对15例患者实施了该手术。9例患者肿瘤位于右侧，6例位于左侧。分别有2例患者因无法控制的出血和巨大转移灶而需要转为开放手术。另外2例患者检测到微小转移灶。除上述出血外，未发生重大并发症；无需输血。目前获得的结果表明该手术在技术上是可行的。因此，我们决定对接受化疗的II B期肿瘤患者也实施腹腔镜腹膜后淋巴结清扫术；迄今为止，1例左侧II B期肿瘤患者已成功接受手术。
