Testicular Cancer - Laparoscopic Retroperitoneal Pelvic Lymph Node Dissection
After a cancerous testicle is removed surgically, the patient and his physician make a decision to undergo the retroperitoneal lymph node dissection based on the CT (computer tomography) findings, the type of testicular cancer, the extent of the cancer, and blood markers. At the University of Chicago , we offer the laparoscopic approach to the conventional open retroperitoneal lymph node dissection. The patient is placed to sleep on the operating table. Then he is turned onto the side. 4-5 small keyhole incisions are made on the abdomen. The surgeon's hands are not inside the patient's body during surgery. A video camera and long instruments are inserted through these keyhole incisions. The surgeon watches inside of the abdomen on a television monitor. Using these long instruments, the great vessels (the vena cava and the aorta) are exposed. The lymph nodes around the great vessels which are the first landing zone for testicular cancer are exposed. After all lymph nodes are dissected, they are placed in a plastic bag and removed from one of the keyhole incisions. The small incisions are closed and the patient is awakened. Postoperatively, the patient is given clear liquids on the evening of the surgery. He is also walking about at least three times daily while in the hospital. Regular food is given to the patient once he can tolerate it. The hospitalization ranges from 2-4 days. The laparoscopic approach to retroperitoneal lymph node dissection offers many advantages. First, instead of a large midline incision made in the open approach, the patient will have only 4-5 keyhole incisions on the abdomen. Smaller incisions mean less pain. Often the patient will require little pain relief medication postoperatively while in the hospital, and minimal if any after discharge. Less pain also means quicker recovery. Most patients will be back to their regular activities in 4-6 weeks following their surgery. In addition to these advantages, the laparoscopic approach also offers a better cosmetic result due to the small and almost negligible incisional scars over time.