Laparoscopic Retroperitoneal Lymph Node Dissection

Open retroperitoneal lymph node dissection (RPLND) has been traditionally used for the management of patients with nonseminomatous germ cell tumors. Over the last decade, laparoscopic retroperitoneal lymph node dissection has gained popularity in several highly specialized centers. Initially only used for staging, laparoscopic RPLND has evolved to a therapeutic procedure capable of replicating the templates used for open RPLND. Perioperative outcomes, including operative time, conversion rates and complications, improve with surgeon experience and are acceptable at high-volume centers. Oncologic outcomes are promising, but require longer term follow-up, and the administration of adjuvant chemotherapy in many studies limits comparison to that of the open technique. In this chapter we present the current state of laparoscopic RPLND in the treatment of testicular cancer and review the technical aspects of the procedure.