Lymph Node Dissection
Removal of the lymph nodes in the back of the abdomen (retroperitoneal lymph node dissection) often plays a role in treating patients with testicular cancer. Some of these patients have no visible disease on their CT scan at the time of the initial diagnosis. However, other patients with more advanced disease may also require lymph node removal, often following chemotherapy.
Traditionally, a retroperitoneal lymph node dissection requires an incision traveling down the entire abdomen. However, this same procedure can be performed through small “button-hole” incisions laparosopically. Laparoscopic retroperitoneal lymph node dissection dramatically reduces the risks and recovery from surgery. However, a very high level of expertise is required to safely perform this procedure, particularly in patients who have received chemotherapy.
Similar to other laparoscopic procedures, the surgeon makes a button-size incision in the center of the abdomen for the insertion of a telescope. After expanding the body cavity with carbon dioxide gas, three or four additional small incisions are made to place narrow tubes used for interchangeable instruments. The surgeon can then visualize the internal organs and the interchangeable instruments on a television monitor.
The intestines are gently detached from the back wall of the abdomen to reveal the lymph nodes located in the retroperitoneal space. Complete exposure and mobilization of blood vessels as large as the aorta or vena cava is necessary in order to remove the appropriate lymph nodes residing between the kidney region and the pelvis. These lymph nodes are then placed in protective plastic bags that close with a purse-string (all while inside the body). The intestines are returned to their normal position. The bags can usually be removed without enlarging any of the small “button-hole” incisions. The skin openings are closed with shower-resistant glue as a substitute for both stitches and bandages.
Results & More
Laparoscopic retroperitoneal lymph node dissection facilitates quicker recovery, less pain, and a lower complication rate as compared to the typical open-incision lymph node removal. Obviously, the primary goal is cancer cure by either removing abnormal lymph nodes or by adequately assessing the need for further treatment. Our success has matched any other published series for laparoscopic retroperitoneal lymph node dissection. A vast experience and a world-class surgical team help ensure this high level of success.
Most patients are discharged from the hospital one or two days following surgery. Risk of damage to surrounding organs, blood clots, pneumonia, and wound infection are each under 2%. Less than 10% of patients have required a transfusion.
Q: How much pain can I expect after the procedure?
A: Pain is typically less with laparoscopic procedures when compared to open-incision surgery. Some abdominal cramps and shoulder discomfort can occur from the carbon dioxide gas used during surgery. This type of pain is best treated with anti-inflammatories rather than narcotics. Although everyone is different, post-operative discomfort is usually easily managed and short-lived.
Q: Is bruising normal after a laparoscopic procedure?
A: When a narrow tube is placed through a button-size skin incision, a small blood vessel just below the skin can break. However, since the snug fit of this tube will compress the blood vessel during surgery, bleeding will often not occur. If this blood vessel were to re-open at a later time, a small amount of blood could track over a large surrounding area (including the genitalia). This is not a true bruise but will have the same appearance. Most important, this finding is not an indication of internal problems.
Q: When can I return to work or other normal activities following my surgical procedure?
A: Scott D. Miller, MD recommends at least two weeks away from work. Very few jobs would require more than four weeks of leave. In many cases, a small amount of light work-related duties are acceptable during the first two weeks. All patients should move around frequently from the time of surgery and resume light exercise at one week (gradually increasing to a normal routine by four weeks). Driving a car is often reasonable in approximately one week if reaction time is good. Of course, Dr. Miller will provide guidance for each individual situation.
Q: How long does the surgery take Dr. Scott Miller to perform?
A: Although many variables can affect the time necessary for Dr. Scott Miller to meticulously perform the surgery, he usually completes the procedure in three to five hours. However, the time away from family members also includes preparation (30-40 minutes), anesthetic reversal (15-20 minutes), and recovery room stay (2 or more hours). Dr. Scott Miller asks patients to arrive two hours prior to this process, during which time family members can remain present. Occasional updates are given to the family by the operating room nurse. Dr. Scott Miller will come to the waiting area when the patient is ready for transfer to the recovery room.
Q: How long do I stay in the hospital following surgery?
A: Most patients are ready for discharge on the day following surgery. However, some patients have remained several days.
Q: Should I donate blood prior to my procedure?
A: Since the risk of needing a blood transfusion is less than 5%, blood donation is optional.
Q: When can I shower or bathe following my surgery?
A: Since shower-resistant glue was used as a substitute for both stitches and bandages, showering is acceptable once discharged from the hospital. Although water will not harm the surgical areas, mechanical cleansing of the incisions should be avoided for the first week to prevent premature removal of the glue. Complete immersion such as bathing or swimming is allowed at two weeks.
Q: How does retroperitoneal lymph node dissection affect sexual function?
A: Retroperitoneal lymph node dissection does not affect erectile function. However, in rare cases, this procedure can affect the ability to properly ejaculate.
Q: How does retroperitoneal lymph node dissection affect fertility?
A: Following lymph node removal, fathering a child is still possible through natural means. However, the sperm count can be affected by decreased ability to ejaculate properly, inadequate production from the remaining testicle, and administration of radiation or chemotherapy. If a patient did not bank sperm prior to surgery, sperm can later be withdrawn directly from the remaining testicle for use with in vitro fertilization.
Q: What long-term follow-up care will I need?
A: A medical oncologist will manage the regimen of follow-up x-rays blood tests.
Q: What other cancer treatments will I need after my surgery?
A: A medical oncologist will recommend any additional necessary treatment. In general, if any cancer is found in the lymph nodes or if the tumor markers become elevated, chemotherapy is usually necessary.