Robot-assisted laparoscopic retroperitoneal lymphadenectomy for metastatic kidney cancer

Paolo Fedelini1, Francesco Chiancone1, Maurizio Fedelini1, Marco Fabiano1, Clemente Meccariello1
  • 1 AORN A. Cardarelli - U.O.C. Urologia (Napoli)


This video describes the main steps of the robot-assisted laparoscopic retroperitoneal lymphadenectomy for lymph node metastasis occurred after radical nephrectomy for renal cell carcinoma. Previous laparoscopic right nephrectomy showed a renal clear cells adenocarcinoma with rhabdoid and sarcomatoid features (Fuhrman grade 3-4). With the patient in left lateral position five ports were placed transperitoneally. Open access technique was used for primary trocar. Three robotic trocars were placed on pararectal, the fourth port 2cm to the iliac crest. The laparoscopic Air-Seal port was placed between the central and the right port on the xifopubic line. The first step was the liberation of intense retroperitoneal adhesions due to previous surgery. Hem-o-lok clips were used to control peritumoral vessels. A large lymphatic retroperitoneal mass of about 10cm in diameter was en-bloc excised. The hemostasis was obtained with the use of Floseal and Tabotamp. The operative time was 120 minutes. Estimated blood loss was minimal. No intraoperative and postoperative complications occurred. The patient was discharged four days after surgery. The patology report confirmed lymphatic metastasis of renal clear cells carcinoma with rhabdoid/sarcomatoid features (Fuhrman grade 4). The Robot-assisted laparoscopic retroperitoneal lymphadenectomy is a feasible approach to treat metastatic lymphnodes.