Robotic Retroperitoneal Lymph Node Dissection for Paratesticular Rhabdomyosarcoma in Children
Michael Ernst, MD, Kristin Ebert, MD, Christina Ching, MD, Daniel Dajusta, MD.
Nationwide Children's Hospital, Columbus, OH, USA.
BACKGROUND: Recent trends have shown an increase in the use of robotic technology for retroperitoneal lymph node dissection (RPLND) at pediatric hospitals. Undergoing robotic RPLND has previously been associated with reduction in postoperative length of stay (LOS), however further granular information is lacking from the literature. Small case series of one to two patients show the safety and efficacy of this approach, however they often include RPLNDs done for both testicular and paratesticular masses. Our objective was to retrospectively evaluate clinical and oncologic outcomes in children and adolescents undergoing robot assisted RPLND for paratesticular rhabdomyosarcoma.
METHODS: We retrospectively reviewed all robotic cases performed at our institution from 2017 to 2021 for patients with a paratesticular rhabdomyosarcoma. We collected data on surgical, pathologic, and clinical outcomes. All surgeries were performed primarily by a single fellowship trained pediatric urologist, with 1 case being assisted by a pediatric urologist co-surgeon.
RESULTS: A total of 4 patients were identified with mean age 16.2 (range 15-17). Robot assisted RPLND was performed on modified left template in 2 patients and modified right template in 2 patients. Additionally, one patient had an inguinal lymph node dissection and one patient had an orchiectomy and partial scrotectomy. Port placement for last 2 patients was HIdES technique with an assist port at umbilicus and four robot ports spaced evenly along the suprapubic line. The average lymph node yield was 23.5 (range: 8-38). All sampled lymph nodes were negative for disease. The average length of stay was 3.25 days (range: 2-6), with no patients requiring ICU stay. Mean OR time was 453.25 minutes (range: 357-530). A drain was left in place in 3 of the 4 patients, and removed after an average of 9 days. Average total narcotic use, morphine equivalent per kilogram, was 1.71 (range: 0.3-2.7). One patient had a Clavien-Dindo grade 3 complication related to intravenous port placement. Chemotherapy was started an average of 11 days after the RPLND.
CONCLUSIONS: Our series demonstrates the feasibility, safety, and efficacy of using the robotic approach for RPLDN in pediatric patients with paratesticular rhabdomyosarcoma. It is one of the largest case series currently in the literature and the only one exclusively done for paratesticular rhabdomyosarcoma. Future studies should continue to build upon current case series and assess long term outcomes for these pediatric patients.
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