Robotic Surgery for Testicular Cancer
Robotic surgery for testicular cancer at a glance
- Robotic surgery for testicular cancer is a minimally invasive surgical procedure that removes cancerous tissue from the testicles.
- Following the surgery, the tissue is then biopsied to determine its stage and plan subsequent treatment steps.
- Robotic testicular cancer surgery avoids a large, open abdominal incision and instead consists of about six tiny incisions in the lower abdomen.
- The surgeon then controls the robotic device to access the cancerous tissue through those incisions.
- Considerations of robotic surgery for testicular cancer include anesthesia reactions, blood clots and damage to nearby organs.
What is robotic surgery for testicular cancer?
Surgeons perform robotic surgery for testicular cancer using robotic devices to remove cancerous tissue from the lymph nodes or to remove the lymph nodes themselves, where testicular cancer generally first spreads. This operation is called retroperitoneal lymph node dissection (RPLND). When performed robotically, it is a robotic-RPLND (RRPLND).
The RRPLND is a less invasive surgery with shorter recovery times than traditional, open RPLND involving a long incision down the abdomen. This is important because the RPLND is a complex surgery that takes time, averaging around six hours.
Cancerous tissues in the testicles tend to follow well-established patterns, originating in the testicles and then onto the lymph nodes. This will guide any subsequent treatment plans such as chemotherapy or radiation.
The purpose of RPLND, open or robotic, is to remove all lymph nodes within a specified anatomic template, according to the location and type of the primary (testicular) tumor. If cancer has spread outside the testicle into these lymph nodes, RPLND may remove all of the cancer tissue. Even if the lymph nodes are negative for cancer, this provides important staging information.
Patients with early stage (usually stage 1) testicular cancer can often choose RRPLND as their primary treatment. Depending on the tumor type and stage, surgery may preclude the need to undergo chemotherapy.
Performing robotic surgery for testicular cancer
After administering general anesthesia, a robotic RPLND consists of six small incisions (about 8-10 mm each) to access the abdomen. The patient is generally placed on his side or his back during the surgery. From those incisions, the surgeon places small instruments and operates by controlling a robotic device to remove the lymph node tissue.
Benefits and considerations
Robotic-assisted surgery for testicular cancer comes with many benefits. The primary benefits are the reduced intrusion and recovery time. Patients will not require as much time to recovery or experience as much overall pain compared with traditional open surgeries.
Despite its potential benefits, those considering an RRPLND should also weigh the risks and considerations. Robotic surgery carries similar risks to those of traditional surgery. Risks and complications of robotic surgery for testicular cancer may include:
- Blood loss requiring transfusion
- Damage to surrounding organs
- Blood clots in the legs or lungs
- Adverse effect of anesthesia.
A common consideration of testicular cancer surgery is its effect on fertility and sexual performance. Patients should discuss the implications of surgery and chemotherapy on their fertility with their doctor and should consider sperm banking if future fertility is desired.
Surgery can usually be performed in a “nerve-sparing” manner to preserve the nerves controlling a patient’s ability to ejaculate normally. However, there is a small chance patients will experience ejaculatory dysfunction despite the fact that sperm continue to be produced within the remaining testicle. Assisted reproductive techniques are available should patients wish to conceive.
Chemotherapy will temporarily shut down the testicle’s ability to produce sperm. Most, but not all, men regain normal sperm production over time (1-2 years).