Open technique for nerve-sparing retroperitoneal lymphadenectomy

Introduction. Retroperitoneal lymphadenectomy (RPLND) is indicated in patie nts with testicular cancer of all stages for staging, prognostic, and thera peutic purposes. Modification of the classic RPLND to incorporate nerve spa ring has reduced the morbidity associated with this procedure with respect to ejaculation and fertility. Technical Considerations. Performance of nerve-sparing RPLND requires an un derstanding of the anatomy of the sympathetic chains, their branches, and t heir relationship to the major structures of the retroperitoneum. The key e lement of this procedure is the prospective identification of the postgangl ionic nerves, which arise from the lumbar sympathetic chains and form an an astomosing network anterior to the aorta and surrounding the origin of the inferior mesenteric artery. Precise dissection of these nerves allows compl ete skeletonization of the great vessels and removal of all lymphatic tissu e, without compromising cancer control. Conclusions. Nerve-sparing RPLND is the procedure of choice for patients wi th testicular cancer in whom surgical therapy of the retroperitoneum is ind icated. The procedure is associated with minimal morbidity and results in p reservation of ejaculation in virtually all patients with low-stage disease and in selected patients with advanced disease or after chemotherapy. (C) 2000, Elsevier Science Inc.