Laparoscopic retroperitoneal lymph node dissection (RPLND) provides patients with a safe and effective way to remove retroperitoneal lymph nodes in patients with testicular cancer. Laparoscopic RPLND is a minimally invasive technique, which provides patients with less discomfort when compared to the traditional open surgery.
Laparoscopic RPLND has resulted in significantly less postoperative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes similar to that of open surgery.
Testicular cancer is one of the success stories in the treatment of malignant tumors. Advances in diagnostic X-rays, radiation and chemotherapy allow for a cure in the majority of cases. Testicular cancer usually spreads in a predictable manner, going first to the lymph nodes, located behind the major organs in the abdomen.
When testes cancer is detected, removal of the testicle (orchiectomy) is first performed. This gives important information regarding the type of cancer and the risk that it may have spread. Blood work, including alpha-fetoprotein (AFP), lactic dehydrogenase (LDH) and quantitative human chorionic gonadotropin (HCG), are done along with a chest X-ray and an abdominal computed tomography (CT) scan to determine the stage of the disease and the best treatment option. Treatment options (depending on the stage and type of cancer) include:
Your surgeon has determined with you that RPLND is the next step in the management of your testes cancer.
What to Expect during Your Preoperative Consultation
During your initial consultation with your surgeon, he or she will review your medical history as well as any outside reports, records and X-ray films (e.g., CT scan, MRI, sonogram). A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for surgery, you will then meet with a patient service surgery coordinator to arrange for the date of your operation.
Note: It is very important that you bring all of your X-ray films and reports to your initial consultation with your surgeon.
What to Expect prior to Surgery
Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your family doctor or primary care physician's office within one month prior to the date of surgery.
These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call the Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was received.
Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following preoperative testing done prior to your surgery:
- Physical exam
- Electrocardiogram (EKG)
- Complete blood count (CBC)
- Blood coagulation profile (PT/PTT)
- Comprehensive metabolic panel (blood chemistry profile)
- AFP (blood work)
- HCG (blood work)
- LDH (blood work)
- Chest X-ray
- CT scan of the abdomen
Preparation for Surgery
Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)
Bowel preparation and clear liquid diet
Drink one bottle of magnesium citrate, which you can purchase at your local pharmacy, the evening before your surgery. Do not eat or drink anything after midnight.
Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.
Clear liquid diet
Remember not to eat or drink anything after midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through. Please follow the diet below.
- Clear broths (no cream soups, meat, noodles, etc.)
- Chicken broth
- Beef broth
- Juices (no orange juice or tomato juice)
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Tea (you may add sweetener but no cream or milk)
- Coffee (you may add sweetener but no cream or milk)
- Clear Jell-O (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowballs (not marshmallow)
During Your Hospitalization
Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.
- Postoperative pain: Pain medication can be controlled and delivered by the patient via an intravenous catheter or by injection (pain shot) administered by the nursing staff. You may experience some minor transient shoulder pain (one to two days) related to the carbon dioxide gas used to inflate your abdomen during the laparoscopic surgery.
- Nausea: You may experience some nausea related to the anesthesia or pain medication. Medication is available to treat persistent nausea.
- Urinary catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while you are asleep) for approximately one day after the surgery.
- Diet: You can expect to have an intravenous (IV) catheter in for one to two days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated; it also provides a way to receive medication.) Most patients are able to tolerate ice chips and small sips of liquids the day of the surgery and regular food the next day. Once on a regular diet, pain medication will be taken by mouth.
- Fatigue: Fatigue is common and should start to subside in a few weeks following surgery.
- Incentive spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you during your hospital stay). Coughing and deep breathing are an important part of your recuperation and help prevent pneumonia and other pulmonary complications.
- Ambulation: On the day after surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can expect to have sequential compression devices (SCDs) along with tight white stockings on your legs to prevent blood clots from forming in your legs.
- Hospital stay: The length of hospital stay for most patients is for approximately one to two days.
- Constipation/gas cramps: You may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help to prevent constipation. Narcotic pain medication can also cause constipation and therefore patients are encouraged to discontinue any narcotic pain medication as soon after surgery as tolerated.
What to Expect after Discharge from the Hospital
- Pain control: You can expect to have some pain that may require pain medication for a few days after discharge. Afterward, Tylenol should be sufficient to control your pain.
- Showering: You may shower after returning home from the hospital. Your wound sites can get wet but must be padded dry immediately after showering. Tub baths are not recommended in the first two weeks after surgery as this will soak your incisions and increase the risk of infection. You will have adhesive strips across your incisions. They will fall off in approximately five to seven days on their own. Sutures underneath the skin will dissolve in four to six weeks
- Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible but should be taken slowly. Driving should be avoided for at least one to two weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity at home on an average of three weeks after surgery. You can expect to return to work in approximately four weeks.
- Diet: There are no dietary restrictions once you return home from your hospitalization.
- Follow-up appointment: If your surgery is performed at The Johns Hopkins Hospital, you will need to call the Johns Hopkins Outpatient Urology Clinic at 410-955-6707 after your surgery date to schedule a follow-up appointment as instructed by your surgeon. If your surgery is performed at Johns Hopkins Bayview Medical Center, please call 410-550-7008 to schedule a follow-up appointment.
- Pathology results: The pathology results from your surgery are usually available in one week following surgery. You may discuss these results with your surgeon by contacting him by phone or in your follow-up appointment in the office.
- Long-term follow-up: Based on the pathology report of your lymph nodes, you may need additional treatment such as chemotherapy. You will need a CT scan, chest X-ray and blood work, including AFP, LDH and HCG, periodically. The frequency of this testing can vary from patient to patient.
To make an appointment for consultation, please call 410-955-6100.
In the event of an emergency and you need to contact someone in the evening hours or on the weekend, please call the paging operator at 410-955-6070 for The Johns Hopkins Hospital or 410-550-0100 for Johns Hopkins Bayview Medical Center and ask to speak to the urologist on call.