Laparoscopic Bilateral Nerve‐Sparing Retroperitoneal Lymph Node Dissection for Testicular Cancer After Chemotherapy

TL;DR

This paper introduces a laparoscopic technique for testicular cancer surgery that preserves nerve function and minimizes invasiveness after chemotherapy.

Contribution

A novel laparoscopic bilateral nerve-sparing RPLND technique is developed and clinically tested for testicular cancer patients.

Findings

The technique preserved bilateral lumbar splanchnic nerves in all 10 patients.

Postoperative ejaculatory function was preserved in 9 out of 10 patients.

Grade 1 chyle leakage occurred in 5 patients but resolved with conservative management.

Abstract

Nerve‐sparing techniques are commonly used in retroperitoneal lymph node dissection (RPLND) for patients with testicular cancer to preserve postoperative ejaculation. Laparoscopic RPLND is applicable to small residual masses; however, nerve‐sparing techniques remain challenging. This study aimed to establish a safe, bilateral nerve‐sparing laparoscopic RPLND via the transperitoneal approach. The technique was developed through cadaveric surgical training (CST) and applied clinically.

Thiel‐fixed human cadavers were used for CST. In patients with testicular cancer after chemotherapy, laparoscopic RPLND was performed based on normalized tumor markers, typically with a residual mass of 5 cm or less. Patients were placed in the lateral position, and four to six ports were used, including the umbilical port; central ports were shared bilaterally. The dissection extent followed a bilateral full‐template approach.

In CST, lumbar splanchnic nerves were identified and preserved, supporting the clinical feasibility of laparoscopic RPLND. The bilateral nerve‐sparing laparoscopic RPLND was performed in 10 patients: 6 with non‐seminoma and 4 with seminoma. The mean pre‐chemotherapy tumor diameter was 2.7 cm (range, 1.2–5.6 cm). The mean blood loss was 165 mL (range, 0–540 mL). The bilateral lumbar splanchnic nerves were preserved in all cases, and postoperative ejaculatory function was confirmed to be preserved in 9 cases. Surgical complications included Grade 1 chyle leakage in 5 patients, all of whom improved with conservative management.

A laparoscopic bilateral nerve‐sparing RPLND technique was developed to achieve both minimal invasiveness and preservation of ejaculatory function. Long‐term follow‐up is necessary to confirm oncological outcomes.

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