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Robotic Retroperitoneal Lymph Node Dissection for Paratesticular Rhabdomyosarcoma in an Adolescent Patient
Ashley W. Johnston, MD, Ruiyang Jiang, MD, Jonathan C. Routh, MD, MPH.
Duke University, Durham, NC, USA.

BACKGROUND: Robotic retroperitoneal lymph node dissection (RPLND) was first described in 2006. Multiple cases series have shown improved blood loss and length of stay, and a reduction in postoperative ileus compared to open and laparoscopic approaches. However, the majority of reports are in the adult population with only 6 pediatric robotic RPLND cases reported in the literature. In our video, we present an adolescent patient who underwent a robotic RPLND for paratesticular rhabdomyosarcoma.
METHODS: Our patient was an 18-year-old male (74 kg, BMI 21) with an enlarging right paratesticular mass. He previously underwent a subinguinal right orchiectomy at an outside hospital that revealed embryonal rhabdomyosarcoma with focally positive margins (which were not further specified). A CT scan revealed multiple subcentimeter pulmonary nodules but was negative for abdominal, pelvic, or retroperitoneal lymphadenopathy. The Soft Tissue Sarcoma Committee of Children's Oncology Group recommends a staging ipsilateral RPLND in patients >/= 10 years old. Thus, the decision was made to proceed with a robotic RPLND with re-excision of his spermatic cord remnant and inguinal scar.
RESULTS: We performed a robotic RPLND utilizing a right-sided modified template with a nerve-sparing technique. Interaortocaval and paracaval node packets were sent as separate specimens. After undocking the robot, the case was completed with an inguinal exploration in which the spermatic cord remnant and inguinal scar were removed and sent to pathology. Total operative time was 282 minutes with an estimated blood loss was 10 mL. Total length of stay was 3 days and the only postoperative complication was a UTI requiring an emergency room visit. All pathologic specimens were negative, thus diagnosing him with Group 1, Stage 1 disease. After completing adjuvant chemotherapy (vincristine, actinomycin, and cyclophosphamide), imaging was negative for evidence of disease.
CONCLUSIONS: Robotic RPLND is rarely reported in the pediatric patient population. The limited case reports have not resulted in any serious adverse events, thus suggesting feasibility and safety. Similar to other reports, our case resulted in minimal blood loss, a short length of stay, no significant adverse events, and a favorable oncologic outcome.


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