MDACC 2018: Indications, Approach, and Outcomes for Robotic RPLND
Dr. Ward suggested that positioning the patient in Trendelenburg is common, he finds that the bowel ends up on the renal vessels making the dissection difficult. Instead, he places patients in the right lateral decubitus position for a modified template. However, in the right lateral decubitus position, it can be challenging for para-aortic lymph nodes. For a complete bilateral RPLND, Dr. Ward will place patients in the left lateral decubitus position. Additionally, use of the TRIMANO® device for an arm holder allows for a greater degree of movement of the robotic arms without interference that occurs with using pillows for arm support. Finally, the ability to be able to use any of the port sites for the camera makes the DaVinci Xi preferable.
Data was shown comparing robotic post-chemotherapy RPLND versus open post-chemotherapy RPLND. There was no significant difference in operative time or lymph node yield. However, there was significantly less blood loss and less likelihood of resection of adjacent organs in the robotic approach. Most of his robotic patients can go home within two days and without drains and thus far he reports no chylous leaks or lymphoceles. This is in stark contrast to when he performs these open in which case patients are often in the hospital for a week.
In conclusion, robotic RPLND can be a safe option, even in the post-chemo setting. It results in a better cosmetic result, decreased blood loss and less likelihood of resection of adjacent organs. Larger or prospective trials will be needed to establish the safety and long-term oncologic data.
Presented by: Dr. John Ward, MD, Professor of Urologic Oncology MD Anderson Cancer Center Houston, Texas
Written by: Written by Dr. Amy H. Lim, MD, PhD, Urologic Oncology Fellow with Dr. Ashish M. Kamat, MD, (@UroDocAsh), Professor of Urologic Oncology & Cancer Research, MD Anderson Cancer Center, Houston, TX at the 13th Update on the Management of Genitourinary Malignancies, The University of Texas (MDACC - MD Anderson Cancer Center) November 9-10, 2018, Dan L. Duncan Building, Houston, TX